Payment for Donation Form

PERTANDINGAN DAN PAMERAN INNOZILLA SDG 2025
PUSAT INOVASI DAN PERUNDINGAN USM
PN NORAINI BINTI MOHAMAD YUSOF | norainimy@usm.my

Name *

Company *

Contact Person

Phone Num *

Address *

Email Address *

Amount (MYR)

Other payment (MYR)

Type of Contribution

Cash

In-kind

Others

Receipt to be issued under

Individual

Department

Company

Name to appear on receipt

Mailing address for receipt

Email for receipt copy

I hereby declare that the information provided above is true and the contribution is made voluntarily to Universiti Sains Malaysia.

Total

MYR

Payment method

Online Payment ( FPX / Credit Card/ Debit Card )

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

SPONSORSHIP / DONATION INNOZILLA SDG 2025, FOI@PULAU PINANG