Darul Arqum Canada

Donation Authorization Form

First Name

Last Name

Phone

Amount of Donation

Donation Option:

One Time Only

Monthly

Payment Options:

Please choose anyone of the following as convenient:

a) Credit Card through paypal b) auto debit through bank c) e-transfers interac to admin@darularqum.org

a) For monthly payments through credit card or if you do not want to share your bank information click donate link, enter an amount $20 or more and check the box "Make this monthly donation" using your paypal account.

Please enter you banking information in the following fields for one time or monthly subscription/ contribution pre-authorization PAD

NOTE: For monthly recurring payments using "Donate" button you need a paypal account, however, you can choose to make one time payment for 12 months contribution using card and email to admin@darularqum.org with details.

Do not forget to press SUBMIT button after completing the form.

b) Name of your Bank

Institution #

Transit #

Account #

VIOD Check Image

Complete Address (we can't issue any Tax Receipt without your complete address)

By Clicking the Submit button, I authorize "Darul Arqum" to collect above mentioned amount from my Credit Card/Bank Account

I understand that this authorization can be cancelled with a 30 days notice through cancellation form with Darul Arqum

Signature (Type your full name below)

Comments(if any):

CRA Approved Charitable Organization
Charitable Reg. # 709549687RR0001

Help Pay Last $100,000* Immediate Loan

if you moved recently or did not receive a tax receipt, Click here to update your Tax Address profile and any other info for the issuance of Tax Receipt.

Signature (Type your full name below)