Authorization I hereby authorize Anglican Social Services Centre 454




Yüklə 6.2 Kb.
tarix10.04.2016
ölçüsü6.2 Kb.

Anglican Social Services Centre 454






Pre-Authorized Remittance Program



Authorization

I hereby authorize Anglican Social Services Centre 454, 216 Murray Street, Ottawa, Ontario, K1N 5N1 to cause a cheque to be drawn on my account each month, as a contribution by me to Centre 454, as follows:


Total monthly contribution to Centre 454 of $ distributed as follows:


Current: $


Special: $ for (please specify)

Name:


Phone #:
Address:
City: Province:
Postal Code:
Financial Institution Name:
Financial Institution Address:
Account #:

Type of Account:





Date: Signature:


Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azrefs.org 2016
rəhbərliyinə müraciət

    Ana səhifə