DONATE

I- PRE-AUTHORIZED DONATION

To set up a pre-authorized payment plan, please fill out the form below:

I hereby authorize my bank to transfer from my bank account each month and pay CENTER OF CULTURES the amount of $, ¢, €, or £…………………………………………………………………………………..to be withdrawn on the………………………………………………………………………..

 Name:…………………………………………………………………………………………..

 Address:………………………………………………………………………………………..

 Email:…………………………………………………………………………………………..

 Account Number:………………………………………………………………………………

 Please date and sign below for automatic payment through your chequing account, and attach a void cheque with this form.

Date:…………………………………………………………………………………………

 Signature:…………………………………………………………………………………….

An official receipt will be issued for tax purposes at the end of every year. You can cancel or modify your monthly payments anytime by contacting CENTER OF CULTURES.

 

II- CHILD SPONSORSHIP APPLICATION FORM

 PERSONAL AND CONTACT INFORMATION

 FIRST NAME: …………………………………………………………………………………

LAST NAME:…………………………………………………………………………………..

 ADDRESS: …………………………………………………………………………………….

 CITY:…………………………………………………………………………………………..

 PROVINCE:…………………………………………………………………………………

 POSTAL CODE:………………………………………………………………………………

 TELEPHONE: (Home)……………………………………………………………………….

 Cell:…………………………………………………………………………………………….

 Business:………………………………………………………………………………………..

 Extension:……………………………………………………………………………………

 EMAIL:………………………………………………………………………………………

 PREFERRED GENDER OF CHILD: MALE / FEMALE

 

III- CHILD SPONSORSHIP(The Silent Cry)

Authorization for Automatic Bank Account Withdrawal

First Name:……………………………………………………………………………………

Last Name:……………………………………………………………………………………

Street address: ………………………………………………………………………………

City:……………………………………………………………………………………………

Province:……………………………………………………………………………………….

Postal Code:……………………………………………………………………………………

Email:………………………………………………………………………………………….

Telephone: (     )………………………………………………………………………………

Fax: (       )………………………………………………………………………………………

Bank Name:…………………………………………………………………………………….

Branch♯:………………………………………………………………………………………

Account♯:………………………………………………………………………………………

Amount of withdrawal: €, £, ¢, $……………………………………………………………………………………….

Frequency: Monthly on………………………….. (Any date from the 1st to the 30th)

I authorize CENTER OF CULTURES (COC) to debit my bank account as indicated above.

Date:…………………………………..Signature:……………………………………………

 If the donation is in honour of someone, please provide details:

In honour of:……………………………………………………………………………………

In memory of:………………………………………………………………………………….

Address of honouree (for acknowledgement letter to be sent):

 ………………………………………………………………………………………………

PLEASE ATTACH A VOID CHEQUE

(For other methods of payment please contact the CENTER OF CULTURES office)