PAD Consent Form

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PAD Consent Form

Please fill up the form to contribute monthly to Darul Falah Islamic Centre. Your contribution will go a long way to facilitate the services and programs that DFIC offers to the Regina Muslim Community

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* Indicates required question

First Name *

Your answer

Last Name *

Your answer

Address *

Your answer

Email *

Your answer

Phone No *

Your answer

I authorize that, Darul Falah Islamic Centre to Debit $........ on 25th from my bank account.

Please Specify the amount:

*

Your answer

Bank Name *

Your answer

Transit No *

Your answer

Account no *

Your answer

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