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臺中一中高三曾姓學生醫療捐款回報表單
謝謝您的善心捐款，請您幫忙協助填寫捐款回報表單，以利寄送收據
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匯款帳號末五碼及匯款人姓名
*
繳交現金請寫無
Your answer
捐款人聯絡電話
Your answer
捐款收據抬頭（抵稅用）
*
Your answer
捐款方式
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親自到學務處繳款
匯款
Other:
捐款金額
*
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收據
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到學校領取
郵寄到家
不領取
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