Pre-Authorized Payment Form 1 Pre-Authorization Form 2 Payment Details Full * First Name * Phone Number * Address Address * Address Line 2 City * Province * Postal Code * Payment Amount Number of Months Payment Method –Select Option– VISA MasterCard AMEX Debit Last Name * Email Address * Form Submitted * –Select Option– Ramadan Jalsa Other If other Enter Description Here Donation Category –Select Option– General Donation Sadaqa Sadaja Jariya Zakat Al-Maal Sponsor a Student Other Credit Card Expiry Date Form Signed * Notes: Pre-Authorized Form Donation * Donation – 6 Months Donation – 12 Months Donation – 36 Months Donation – Custom One Time Donation Amount Amount Amount Amount Amount $0 for each month, for 6 installments$0 for each month, for 12 installments$0 for each month, for 36 installments$0 for each month, for 999 installmentsOne time payment of $0 Donation Summary Submit Please Wait… ← Previous Next →
