The donation process|ashinaga.org
ashinaga.org

The donation process

 

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After completing the following form, please click on "Confirm entered information."
Please do not use your browser's "back" button, as it may disrupt processing of the transaction.
Note: Fields marked with an asterisk (*) are required.

Donor information

Name  First    Family 
Sex       
Year of birth
Please use 4-digit format (e.g., 1975).
Postal code   - 
Prefecture/province/state 
City 
市区町村をご入力ください。
Address line 1 
市区町村以降の住所をご入力ください。
Address line 2
アパート名・建物名とお部屋番号をご入力ください。
Address line 1 
Address line 2
City 
Prefecture/province/state 
Postal code(up to 15 characters). 
Country 
Telephone number(up to 20 digits). 
Enter using single-byte numerals.
E-mail address 
Enter using single-byte alphanumeric characters.
To confirm your e-mail address, please enter it again.
Is this the first time you have donated to Ashinaga?      

Note: For other than first-time donors, please enter your donor ID, if known (a 10-digit number beginning with 1 through 5).
Donor ID:

Donation details

How would you like your donation used?   
 
 
 
Donation amount 
The minimum donation is 500 yen.
Please do NOT use a comma to separate digits.
 yen
Delivery of donation certificate and program report
May we send you an annual donation certificate and program report?
     
Delivery of receipt for donation
While we will send an annual donation certificate listing the total of all your donations during the year, in order to minimize costs we normally do not issue receipts for individual donations. If you require an individual receipt, please indicate below.
     
Note: The date of the receipt will not be the date funds are deducted from your account, but the date that your donation is received by Ashinaga.

Credit card details

Card number 
Please do not use hyphens or spaces.
Expire date   Month  Year
Security code    
The security code generally consists of the last 3 or 4 digits following the card number printed on the reverse of the card (American Express security codes appear on the front of the card).

The following credit cards may be used.
We accept the credit cards with the following brand marks.

Bank account Information

Bank code 

Bank account Information

Bank user_name 
全角カタカナで入力して下さい。

Convenience Information

Convenience 
Please check the "I agree" box below to indicate you consent to the terms and conditions described above.
 

Please feel free to send a message to the orphans your donation will help. (Max.: 3,000 characters)

Message

We would be grateful if you could take a few minutes to complete the following survey.

How did you hear of this Web site?  
 
 
 
 
 
 
 
 
 
 
 
We do not use donors' personal information for any purpose other than fundraising, and we implement appropriate measures to ensure the security of all information provided.