Fellowship.ca - Freedom - Donation Submission Form

To submit a Pre-Authorized Debit Agreement form and voided cheque please complete and submit the following form.

This form is to be completed by those wishing to make a donation to a specific missionary, chaplain, appeal, or project within the Fellowship.

To make a credit card donation, visit: www.fellowship.ca/Donate

If you would prefer the print version of this form, click here.

PERSONAL INFORMATION for receipting purposes

* Name:

* Address:

* City:

* Province:

* Postal code:

A phone number and/or email address is required in case we need to follow up with you regarding your donation.

* Phone (including area code): ( ) -

Email:

DONATION INFORMATION

* This donation is:

Recurring
One-time

I wish to make a donation towards the following (space has been provided for two designations in case you wish to donate towards more than one missionary/chaplain/project):

* Missionary / chaplain / project name:

* Amount:

Missionary / chaplain / project name:

Amount:

PRE-AUTHORIZED PAYMENT PLAN

To use the Pre-Authorized Payment Plan please use the sample cheque below to provide the information requested.

* Transit (Branch) number:

* Financial institution number:

* Account number:

* Please include an image of a voided cheque.

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Typing your name in the space provided below indicates your signature on this document.

* Signature:

* Date:

Donor Designated Funds Policy — Spending of funds is confined to programs and projects approved by the organization. Each restricted contribution designated towards such an approved program or project will be used as designated with the understanding that when the need for such a program or project has been met, or cannot be completed for any reason determined by the organization, the remaining restricted contributions will be used where needed most.