For your convenience, Wild At Heart now provides the option of making contributions by credit card.

Just fill out

the "automatic debit authorization form" below, authorizing the Wild at Heart Legal Defense Association,
Taiwan to make a debit/debits from your designated credit card, to allow for continuing contributions to
environmental issues of special concern.
Please print and fill out:

Wild at Heart Legal Defense Association, Taiwan Automatic Debit Authorization Form
Receipt □Individual National ID No.
recipient: □Company GUI:
Phone: Home: Office: Mobile:
Address:
Date of
E-mail:
birth: (For convenient contact and quick delivery of important notifications)
1. This information is necessary in order to issue and deliver receipts.
2. If the recipient of the receipt is different from the cardholder making the contribution, please
Notes:
specify your relationship with the cardholder.
3. Please note whether your credit card's period of validity covers the period of contributions!
【Credit Card Information】
】(Please print)
Card type: □VISA □MASTER CARD □JCB
□U Card
Card No.: Expiration
＿＿＿＿─＿＿＿＿─＿＿＿＿─＿＿＿＿ date: ____ mn _______yr
Card security
Issuing code (3-digit
Signature:
bank: number on (Must be identical to signature on card's
reverse side): reverse side)

□Single contribution amount: NT$ .

□Fixed monthly contribution amount (in NT$): □300 □500 □600 □800 □1000 □Other
amount: NT$ .
Period for fixed monthly contributions:
Siganture:
Start: __yr mn; end: __yr mn
Date: __yr mn day
Or: □Until notice of cancellation
Purpose: □Indo Pacific Humpback Dolphin ("Matsu fish") research & conservation □Authorize
Wild at Heart Legal Defense Association to allocate contribution for specific purposes

Please fax the above information to: 02-2382-5810, or E-mail: comment@wildatheart.org.tw, or mail to:
Wild at Heart Legal Defense Association, Taiwan, 12F, 86 Chongcing South Road Sec. 1, Taipei,
Taiwan 10045.

【Please note:】
※Wild at Heart will automatically debit your card from this date until such time as we receive notice of your
※Receipts issued by Wild at Heart may, in accordance with the law, be deducted or reported as expenses for
cancellation or change in authorization.

※Receipts for fixed monthly contributions will be issued together by mail at year's end for the convenience of
the current year on your consolidated income tax return.

※Upon receipt, Wild at Heart will confirm the information you have submitted by phone or e-mail.
your records and tax statements.

※Wild at Heart's web address is http://www.wildatheart.org.tw; for the Matsu Fish Conservation Union,
http://twsousa.blogspot.com. Please visit these sites to find the latest information on environmental issues in

※
Taiwan and efforts to save the Indo Pacific Humpback Dolphin, or Matsu fish.
Please call 02-23825789 to inquire about any questions you may have.