Monthly Giving Form

Purpose: This form is intended to enroll and collect information from individuals who wish to support our mission through automated monthly donations.

Donor Information

Full Name: {fullName}

Email Address: {email}

Phone Number: {phoneNumber}

Mailing Address: {streetAddress}, {city}, {state}, {postalCode}, {country}

Donation Details

Monthly Donation Amount: ${monthlyAmount}

Preferred Donation Date: {donationDate}

Start Month: {startMonth}

Payment Method

Payment Type: {paymentType}

{#isCreditCard}

• Cardholder Name: {cardholderName}
• Card Number (last 4 digits): {lastFourDigits}
• Expiration Date: {cardExpiry}

{/isCreditCard}

{#isBankDraft}

• Bank Name: {bankName}
• Account Holder Name: {accountHolder}
• Routing Number: {routingNumber}
• Account Number (last 4 digits): {accountLastFour}

{/isBankDraft}

Designation (If Any)

{^hasDesignation}No specific designation requested.{/hasDesignation}

{#hasDesignation}This donation is designated to: {designation}{/hasDesignation}

Communication Preferences

Would you like to receive updates about your impact? {wantsUpdates}

Additional Notes

{additionalNotes}

Agreements

Authorization: By submitting this form, I authorize the above amount to be charged automatically from my selected payment method on a monthly basis beginning from the selected start date.

Signature: {signature}

Date: {signedDate}