Contribute Monthly Support

You may set up your donations to be automatically withdrawn on a monthly basis from your bank account or charged each month to your credit card. Please carefully fill out the following form which will be submitted to our Donor Development department.

Name & Address

Full name (required)
Email (required)
Telephone
Address Line 1 (required)
Address Line 2
City (required)
Province (required)
Postal Code (required)

Payment Details

Amount (required)
What would you like to support?
Processing Date (required)

Payment type (required)Pre-authorized debitCredit card

Provide us with your account informationEnter account informationImage of a VOID cheque

Transit number
Branch number
Account number

Upload image of a VOID cheque

Please note that for pre-authorized monthly credit card transactions, a staff member from our finance office will contact you to collect your credit card information.

Notes for the finance office (optional)

Pre-authorized Donation Agreement

I Agree (required)

I may revoke my authorization at any time, subject to providing 15 days notice. To obtain a sample cancellation form, or for more information on my right to cancel a PAD Agreement, I may contact my financial institution or visit www.canpay.ca.

I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with the PAD Agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit www.canpay.ca.

Signature (required)