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Pre-Authorized Debit Form


Pre-Authorized Cheque/Debit (Billing Cycle: Monthly)

Credit Card (Billing Cycle: Monthly)

I authorize AL-BAAQI FOUNDATION to charge the credit card listed below for the amounts set forth above,
This authority is to remain in effect until AL-BAAQI FOUNDATION has received written notification from me/us of its change or termination. This notification must be received at least thirty (30) days before the next debit is scheduled at the address provided above. I/We may obtain a sample cancellation form, or more information on my/our right to cancel Pre-Authorized Debit Agreement at my/our financial institution or by e-mailing at donate@albaaqi.ca.
I/We have certain recourse rights if any debit does not comply with this agreement. For example, I/We have the right to receive reimbursement for any Pre-Authorized Debit that is not authorized or is not consistent with this Pre-Authorized Debit Agreement. To obtain a form for Reimbursement Claim, or for more information on my/our recourse rights, I/We may contact my/our financial institution

Donor Information:

Note: Forward this completed form to AL-BAAQI FOUNDATION via Mail (or) in person (or) email, please keep a copy for your records.

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