PLEDGE FORM FAIZAN-E-MADINA CANADA Method of Payment · For Direct deposit in Construction account...
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Personal Information FAIZAN-E-MADINA CANADA _________________________________________________________________________ Last Name First name _________________________________________________________________________ No. Street Apt.No. _________________________________________________________________________ City Prov. Postal Code (_______)___________________________(_______)_____________________________ Tel(Home) (Cell / Business) _________________________________________________________________________ Fax Email Credit Card No. |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Expiry Date |__|__|__|__| CSV |__|__|__| Institution _______________ 1. Credit Card Bank Name & Ad dress ___________________________ _ ________ Account No. |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Starting Date |__|__|__|__|__|__| Transit |__|__|__|__|__|__| 2. Monthly Bank Withdrawal (please enclose your void cheque) 3. Cheque Enclose I give my permission to Faizan-e-Madina Canada to withdraw from my bank account or credit card mo nthly pledge that I have indicated above this pledge will use for any good deeds and failure to pay shall give rise to no liability on your part regardless of the forfeiture or damage. I also understand that I may end this agreement at any time with a written notice. Signature ___________________________ (As on financial institute) (This signature will consider your Authorization for any payment method in this form for donation) Method of Payment (Tax deductible receipt will be ready for your donations) $30 , $50 , $75 , $100 or other Amount $________________ Here is my commitment Monthly deduction One Time Donation For Direct deposit in Construction account : Bank CIBC , Acc.Name : Faizan-e-Madina Canada , Transit# 05522 Acc.No 1317113 for Masjid regular Donations Acc. No 1211919 other informations are same. TAKE ADVANTAGE OF THIS BLESSED OPPORTUNITY AND BE AMONG THE CHOSEN ONES TO HELP BUILD THE HOUSE OF ALLAH. 595 Albion Rd, Etobicoke ON M9V-1A1 [email protected] 416-878-7346 , 416-371-3902 , 416-856-6040 I would like to refer the following persons to participate in this blessed project Name ________________________________ Phone ______________________ Name ________________________________ Phone ______________________ PLEDGE FORM
Transcript of PLEDGE FORM FAIZAN-E-MADINA CANADA Method of Payment · For Direct deposit in Construction account...
Personal Information
F A I Z A N - E - M A D I N A C A N A D A
_________________________________________________________________________ Last Name First name _________________________________________________________________________ No. Street Apt.No. _________________________________________________________________________ City Prov. Postal Code (_______)___________________________(_______)_____________________________ Tel(Home) (Cell / Business) _________________________________________________________________________ Fax Email
Credit Card No. |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Expiry Date |__|__|__|__| CSV |__|__|__| Institution _______________
1. Credit Card
B a nk N a m e & A d dress ____________________________ _ _ _ _ _ _ _ _ Account No. |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Starting Date |__|__|__|__|__|__| Transit |__|__|__|__|__|__|
2. Monthly Bank Withdrawal (please enclose your void cheque)
3. Cheque Enclose
I g ive m y p e rm is s io n to F a iz a n -e -M a d in a C a n a d a to w ith d ra w fr o m m y b a n k a c c o u n t o r c r e d it c a rd m o nthly pledge that I have indicated above this pledge will use for any good deeds and failure to pay shall give rise to no liability on your part regardless of the forfeiture or damage. I also understand that I may end this agreement at any time with a written notice. Signature ___________________________ (As on financial institute) (This signature will consider your Authorization for any payment method in this form for donation)
Method of Payment
(Tax deductible receipt will be ready for your donations)
$30 , $50 , $75 , $100 or other Amount $________________
Here is my commitmentMonthly deduction One Time Donation
For Direct deposit in Construction account : Bank CIBC , Acc.Name : Faizan-e-Madina Canada , Transit# 05522 Acc.No 1317113 for Masjid regular Donations Acc. No 1211919 other informations are same.
TAKE ADVANTAGE OF THIS BLESSED OPPORTUNITY AND BE AMONG THE CHOSEN ONES TO HELP BUILD THE HOUSE OF ALLAH.
595 Albion Rd, Etobicoke ON M9V-1A1 [email protected] 416-878-7346 , 416-371-3902 , 416-856-6040
I would like to refer the following persons to participate in this blessed project
Name ________________________________ Phone ______________________
Name ________________________________ Phone ______________________
PLEDGE FORM
