Give Monthly (EFT)

Name *

First Name

Last Name

Name of Spouse (Optional)

First Name

Last Name

Phone

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Monthly Donation Amount *

$10

$25

$50

$83.33

$100

$250

$500

Other (Fill in Blank Below)

Type of Bank Account *

Checking

Savings

Agreement *

By checking this option, I agree to use my bank account as a payment method & authorize this organization to debit my bank account to fulfill my donation.

I Agree