Give online at: www.paoc.

org/donate/jamierauch

Commitment Form- Jamie Rauch (M220626)

*Name: ________________________________________________________________________________________
*Mailing Address: _________________________________________________________________________________
______________________________________________________________________________________________
*City ______________________________ *Province: _____________
*Phone: (

*Postal Code: ____________________________

) ____________________________ *Email: ________________________________________________

*Required Information

Option 1 Automatic Withdrawal

I would like my donation deducted automatically from my bank account.

Enclosed is a void cheque and I authorize the PAOC to debit my bank account for $ ______________
Per month from the account specified on the attached void cheque.

Amount (per month): $ _______________ Starting (Month): ________________ Ending (optional): ______________
Signature: _______________________________________________

Date: _____________________

This authorization may be canceled upon written notice

Option 2 Cheque
Enclosed is a cheque for $___________ as a this-time donation.
Enclosed are post-dated cheques in the amount of $ ________ (each).
Please make cheques payable to: The Pentecostal Assemblies of Canada
2450 Milltower Court: Mississauga: ON: L5N 5Z6: 905. 542. 7400
Memo: Jamie Rauch (M220626)

Option 3 - Credit Card

I would like to make a donation this time of $ ______________________________________.
I authorize the PAOC to debit my credit card for $ ________ per month starting ___________.
Visa

MasterCard

Name: ________________________________________________________________________________
Card Number: ______________________________________________ Expiry Date: ________________
Signature: _____________________________________________________________________________
This authorization may be canceled upon written notice.

OFFICE USE
M220626 - Jamie Rauch
cc: Mission Canada