Monthly Donations

To set up monthly donations, you can download the printable pdf form here and mail that to our office.

Or, fill in the online form below:

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
I (we) authorize Christian Service Centers of Canada Inc to process a monthly debit in the amount of $
from my (our) account* on the 15th of each month beginning on
*A void cheque from the bank account will need to be submitted separately from this form.
This donation is made on behalf of
- An Individual
- A Business or Charity
Statement of Acknowledgement*
- I Agree
I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD agreement. To obtain more information on my recourse rights,obtain a sample concellation form or for more information on my right to cancel this PAD agreement I may contact my financial institution or visit www.cdnpay.ca I may revoke my authorization at any time, subject to providing notice of at least seven business days, by contacting CSC by phone at 519-690-1615.
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Name
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