Complete the form below and Mail or Fax to:
The American Pan-African Relief Agencies, Inc.
P.O. Box 1626Triburo Station
New York, NY 10035
Fax: 1-718-920-1548

(Please click here if you wish to donate medical, educational or other goods or services to APARA)

Check the fund(s) where you want your financial donation(s) to be applied:

AIDS ORPHANS & VULNERABLE CHILDREN FUND
APARA HIV/AIDS FUND
CHILD SPONSORSHIP FUND
GENERAL SUPPORT FOR APARA
GENERAL RELIEF SERVICES FUND

If you are donating by credit card, please provide the following information:

Card Type: Visa MasterCard AmEx Discover Diners JCB

Personal or Corporate:   Personal  Corporate

If corporate, name of corporation:_______________________________________

If personal, name (as it appears on Card):________________________________

Amount of Donation:___________________________________

Card Number:__________________________________ Exp. Date:___/___/_____

Signature:______________________________________________________

To make donations through ACH/Electronic Checking Transaction (USA Banks Only), please provide the following Checking Account information:

Personal or Corporate:   Personal  Corporate

If corporate, name of corporation:_______________________________________

Amount of Donation: _________________________________
 
Bank Name:______________________________________________________

Bank Address:____________________________________________________

ABA Routing:_______________________[9 digits between the colons (|:00 1234567|:) on check]

Corporate Address:________________________________________________________

City____________________ State::_________________ Zip Code:__________

Telephone:_________________________ Fax:__________________________

E-Mail:_________________________________________