Queen Sirikit Centre for Breast Cancer Foundation

DONATION

Option
01

CHEQUE / BANK

( Crossed “Account Payee only” )
Payable to “Queen Sirikit Centre for Breast Cancer Foundation” and send to our office

Account Name: “Queen Sirikit Centre for Breast Cancer Foundation”

Siam Commercial Bank, Thai Red Cross Branch,

Saving Account No. 045-492405-0

Kasikorn Bank, Chulaongkorn Hospital Branch,

Saving Account No. 623-2-05989-1

Bangkok Bank, Chulalongkorn Hospital Branch,

Saving Account No. 913-7-01266-3

Please complete the form and send to us by
Fax No. 02-696-8634
Email : info@qscbcfoundation.org

Option
02

DONATE ONLINE BY CREDIT CARD

PAYMENT INFORMATION

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First Name*

Last Name*

Postal address*

Contact phoneephone No.*

Email.*

Donation Amount*

Terms of agreement

Please check your information before submit form.
Please note that Queen Sirikit Centre for Breast Cancer Foundation will not be able to refund your donation in any case.

I have read and understand this agreement, and I accept and agree to all of its terms and conditions.