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BibleCenteredMinistriesInternationalCanada(Inc.

DonationData

I/WewishtosupportthefollowingBoardapprovedministryofBCMInternational(Canada)Inc.
Theministryof______________________________________________________________
Pleasechooseoneofthedonationformsincluded.

OneTimeDonation

NameandAddressofDonor________________________________________________________________________
______________________________________________________________________________________________

TotalDonationAmount__________
___cheque(payabletoBCMInternationalCanadaInc)
___cash(enclosed)
__CreditCard:CardType________________CardNumber________________________Exp.Date|__________
Signature________________________________________

PreAuthorizedDonation

I/WeherebyauthorizeBCMInternational(Canada)Inc.todebitmy/ouraccountonthe
(pleasecircleone)1st15thor30thofeachmonthuntilfurthernotice.

Intheamountof$______
Tobegininthemonth____________
Designatedtotheministryof______________________________________

My/OurName________________________________
Address_____________________________________
City________________________________________Prov.______________P.C.___________________
PhoneNumber(______)______________________________
BankName_________________________________________

PleaseattachaVOIDchequetothisformandsignbelow
(Twosignaturesarerequiredforjointaccounts)
Signature___________________________________________
Signature___________________________________________

Imayrevokemyauthorizationatanytime,subjecttoprovidingnoticeof30days.Oobtainasamplecancellationform,orfor
informationonmyrighttocancelaPADAgreement(PreauthorizedDebitAgreement),Imaycontactmyfinancialinstitution
orvisitwww.cdnpay.ca
Ihavecertainrecourserightsifanydebitdoesnotcomplywiththisagreement.Forexample,Ihavetherighttoreceive
reimbursementforanydebitthatisnotauthorizedorisnotconsistentwiththisPADAgreement.Toobtainmoreinformation
onmyrecourserights,Imaycontactmyfinancialinstitutionorvisitwww.cdnpay.ca.

Pleasereturncompletedformtomissionrepresentativeorviapostto:
BCMInternational(Canada)Inc.
685MainStreetEast,HamiltonONL8M1K4
Phone9055499810TollFree18772729262Fax9055497664Email:mission@bcmintl.ca

Giftsareacknowledgedwhenreceivedandanofficialreceiptisissued.

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