Void Check Donations

Campaign of 400 families

Join the list of families who will donate $70 per month for the future project.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Monthly contributions

Pre-authorized Payments
$70$140$210Other
Start date*

MonthDayYear
Date
You can cancel this agreement at any time by sending written notice to the Aylmer Mosque at info@mosque-aylmer.ca.
File Upload

Cancelof
Signature
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Campaign of 400 families