Quick Donation Form

Quick Donation Form
Nom*

First nameLast name
E-mail*
Phone number*
Address

Line 1

Line 2

CityRegion

Postal code
Destination

Future community centerAylmer mosquePortage mosque
Donation type*
Chose the type of contribution
Monthly contributions

Pre-authorized payments
Monthly amount*
Starting from*

MoisJourAnnée
Upload a void check*

Upload a pdf or image of your void check to authorize the mosque to process for recurrent payments
Cancelof
By submitting this form, I hereby authorize Aylmer Mosque Association to withdraw from my bank account the monthly pledge for the Aylmer Mosque that I have indicated above. I also understand that I may end this agreement at any time with written notice.
One-time Donation
Payment method*

Credit / Debit cardInterac e-transferCash (pledge)Cheque (pledge)
You can write a cheque to the name on The Mosque of Aylmer
Send an e-transfer to finance@mosque-aylmer.ca in case a password is required, please use : mosque.

Monthly contributions