Preparing Donation Form
Donation Information
Monthly donation
$
*
Additional Information
Type of gift:
Monthly donation
Deducted on
Day 1 of every month
Day 15 of every month
Starting:
Ending:
Corporate:
This donation is on behalf of a company
Billing Information
Title
Mr.
Ms.
Mrs.
Miss
Master
Dr.
Rev.
Name
*
Last name
*
Country
Canada
United States
*
Address
*
City
*
Province
<Please Select>
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
AA
AE
AK
AL
AP
AR
AS
AZ
CA
CO
CT
CZ
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VT
Vic
VA
VI
WA
WI
WV
WY
*
Postal code
*
Phone
*
Email
*
Payment Information
Deducted from
Credit card
Chequing A/C (Canadian banks only)
Name on card
*
Card number
*
Payment method
American Express
MasterCard
Visa
*
Expiration date
01
02
03
04
05
06
07
08
09
10
11
12
/
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
*
Security code
*