청주희망일굼터

후원신청서 <TABLE style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; BORDER-COLLAPSE: collapse; BORDER-RIGHT: #000000 0.28pt solid; mso-table-overlap: never"> <TBODY> <TR> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 64.05pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 성 명</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 165.87pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=2> </TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 78.2pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 주민등록번호</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 188.52pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=4> -</TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 64.05pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 48.41pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 주    소</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 432.59pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 48.41pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=7> □ 자택 □ 직장 ※ 기부금 영수증 발급시 필요합니다. </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 64.05pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 전화번호</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 165.87pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=2> </TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 78.2pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 휴대전화</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 188.52pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=4> </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 64.05pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 직 업</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 165.87pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=2> </TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 78.2pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 이 메 일</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 188.52pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 30.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=4> </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 64.05pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 69.96pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center rowSpan=3> 후원구분</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 77.27pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> CMS</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 88.6pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center>   </TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 78.2pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 69.96pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center rowSpan=3> 납부희망 일자</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 5일</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center>   </TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 10일</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center>   </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 77.27pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 자동이체</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 88.6pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> </TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 15일</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center>   </TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 20일</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 77.27pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 기 타</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 88.6pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center>   </TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 25일</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center>   </TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 30일</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 47.13pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 23.32pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center>   </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 64.05pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 31.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 후원금액</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 432.59pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 31.81pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=7> 10,000원( ), 20,000원( ), 30,000원( ), 기타( )</TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 64.05pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #cccccc; HEIGHT: 34.64pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center> 계좌번호</TD> <TD style="BORDER-BOTTOM: #000000 0.56pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 432.59pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #ffffff; HEIGHT: 34.64pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 0.56pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=7> (은행명 : 계좌번호 : )</TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.56pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 496.64pt; PADDING-RIGHT: 5.1pt; HEIGHT: 308.34pt; BORDER-TOP: #000000 0.56pt solid; BORDER-RIGHT: #000000 1.41pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=8> [개인정보 및 고유식별정보 수집 및 이용 동의] - 수집 및 이용목적 : 효성CMS 출금이체를 통한 요금 수납 - 수집항목 (개인정보) : 성명, 전화번호, 휴대전화번호, 금융기관명, 계좌번호 동의함 □ 동의안함 □ (고유식별정보) : 주민등록번호 동의함 □ 동의안함 □ - 보유 및 이용기간 : 수집, 이용 동의일부터 CMS 출금이체 종료일(해지일)까지 - 신청자는 개인정보 및 고유식별정보 수집 및 이용을 거부할 권리가 있으며, 단, 거부 시 자동이체 신청이 처리되지 않습니다.   [개인정보 제3자 제공 동의] 동의함 □ 동의안함 □ - 개인정보를 제공받는 자 : 효성에프엠에스(주) (금융감독위원회 허가를 받은 효성그룹 전자금융서비스 사업자) - 개인정보를 제공받는 자의 개인정보 이용 목적 : CMS 출금이체 서비스 제공 및 출금동의 확인 - 제공하는 개인정보의 항목 : 성명, 금융기관명, 계좌번호, 주민등록번호, 전화번호, 휴대전화번호 - 개인정보를 제공받는 자의 개인정보 보유 및 이용기간 : CMS 출금이체 서비스 제공 및 출금동의 확인 목적을 달성할 때 까지 - 신청자는 개인정보에 대해 수납업체가 효성에프엠에스(주) 제공하는 것을 거부할 권리가 있으며, 거부 시 출금이체 신청이 처리되지 않습니다.   20 년 월 일   신청인 : (인 또는 서명) 장애인직업재활시설희망일굼터 귀중</TD></TR></TBODY></TABLE> 주소 : 충북 청원군 남일면 효촌송정3길 29 / 전화 : 043-298-2900 / FAX : 043-292-8899     <a href='javascript:fileFilterViewer("http://cfile257.uf.daum.net/attach/27171F33539AA8673102A1", "/cfile257/27/171F33539AA8673102A1", "양식-후원신청서.hwp", "grpid%3D1ULct%26fldid%3DCvfe%26dataid%3D2%26fileid%3D1%26regdt%3D20140613162951&url=http%3A%2F%2Fcfile257.uf.daum.net%2Fattach%2F27171F33539AA8673102A1")'><img src="//i1.daumcdn.net/icon/editor/p_hwp_s.gif" border="0" alt="첨부파일" class="vam"/> 양식-후원신청서.hwp</a>