Request for Information Form

YES, I want to support ProFauna Indonesia

Contact Information

Name *

Date of birth

Month

Day

Year

Address *

Sex *

Phone number

Occupation

Zip code *

Email *

I donate *

At least $ 100

Above $ 100, $

I donate Above $ 100, $

I wish to pay by *

Check

Transfer by bank

Accounts Information

please send to ProFauna Indonesia the copy of deposit slip

Account number	53093460 (USD Account)
Account name	PROFAUNA INDONESIA
Bank name	Bank Negara Indonesia (BNI)
Bank address	Jl. Basuki Rahmat Malang, Indonesia
Swift code	BNINIDJAMLG

Account number	011-3125273 (IDR Account)
Account name	Perkumpulan ProFauna Indonesia
Bank name	BCA Malang

If you would like to return by post, please send to:

Jl. Raya Candi II 179, Klaseman, Karangbesuki
Malang 65146, Jawa Timur - Indonesia

Search form