Leukodystrophy Australia Recurring Credit Card Donation Form

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If you choose to opt in for further information, your name/contact details will never be released to any third party, or used for purposes other than described.

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Payment Method

Credit Card (Visa, Mastercard, Amex)Cheque made out to Leukodystrophy AustraliaDirect Debit BSB: 193-879 Acc No: 457864204

Donation Amount

Donation Frequency

Thank you for your planned donation by Direct Deposit or Cheque. This process requires you to either post a cheque, or complete your donation via your own online banking.

Direct Deposit details:

Bank of Melbourne
Australian Leukodystrophy Support Group Inc
BSB: 193 879
A/C: 457864204
Please enter your name in the Reference field.

Cheque:

Payee: Australian Leukodystrophy Support Group Inc

Mailed to:

Leukodystrophy Australia
P O Box 2550,
Mount Waverley
VICTORIA 3149
AUSTRALIA

Please select frequency preference and adjust/set the recurring amount you wish to pay

Weekly Donation(AUD for each week)

Fortnightly Donation(AUD for each two weeks)

Monthly Donation(AUD for each month)

Quarterly Donation(AUD for each three months)

Annual Donation(AUD for each year)

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To cancel a recurring donation, please contact us by email or phone and we will handle this offline.

PE TEST FORM ONLY