ESEUS
Aldapeta 49, 20007, Donostia - San Sebastián
+34 943 476 000

COLLABORATION FORM

If you wish to collaborate on the project, you may do so through the collaboration sheet by filling out this form, indicating your personal information, collaboration amount, and payment method you wish you use.

FORM

Name (compulsory)

Surname(s) (compulsory)

Address / Residence (compulsory)

City (compulsory)

Postcode (compulsory)

Province (compulsory)

Phone (compulsory)

E-mail (compulsory)

N.I.F. (only if you wish to make a tax write-off)

COLLABORATION

My contribution will be...  50 € 100 € 200 € 500 € 1.000 € Another amount

Amount (if 'Another amount' was marked)

FREQUENCY
 Monthly Quarterly Six-monthly Annually Once

PAYMENT METHOD

If the "from my checking account" option was selected, enter your complete IBAN number