... Enclosed is my cheque for $......................... payable to "PBRS G42 Restoration Appeal"
OR
... Please charge $......................... to my credit card account: Bankcard VISA Mastercard
Card Number: ............ ............ ............ ............
Name on Card: ............................................... Expiry Date: .....................
Signature: ............................................................... Date: .....................
Name: ........................................................................................................
Address: ....................................................................................................
......................................................................................... Post Code: .....................
Telephone: ...............................................................