PRE-AUTHORIZED DEBIT (MONTHLY)

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

This form is for a:

New authorization
Change Information

Date when you would like this donation to start?

Monthly transfer date:

1st of each month
15th of each month

? When would you like your support to be debited.

Monthly Donation Amount

Designate this donation for:

Please use my donation for the above missionary or project

Transit number

five-digit number that identifies the branch of the banking institution

Institution Code

Directly to the right of the transit number is the institution code (sometimes called the designation number).

Bank account number

The account number identifies the bank account from where money will be withdrawn when the recipient deposits the cheque.

Approval

I hereby authorize Kontakt Canada Ministry Association to charge my account each month for the amount indicated above. This authorization also includes permission for Kontakt Canada Ministry Association to reverse any charges made in error. This authority will remain in effect until I submit written notice to cancel or modify it. I understand that it may take up to three weeks from the date Kontakt Canada Ministry Association receives this information for the first electronic gift to be processed, and up to three weeks to implement any requested changes.

Signature

Clear Signature

About Kontakt Canada

Kontakt Canada, a Canadian missions agency and the KontaktCanada website, are a joint ministry partnership of Kontaktmission International and Neues Leben, Germany.

Please visit:
www.GoKMUSA.org
www.neues-leben.de
www.kontaktmission.de

CONTACT

Inquiries and Official Business:
Kontakt Canada Ministry Association
2787 St. Moritz Way, Abbotsford, BC V3G 1C3

Questions regarding service opportunities,
speaking opportunities, or joint partnerships:
Rob Harris: rob@kontaktcanada.org

Charitable Registration Number (BN): 107770703BC0001

Contact Us

We want to hear from you! Fill out this contact form, and we will get back to you soon. Thank you for your interest in Kontakt Canada.