1. Monthly general support: $ 10 $ 20 $ 30 $ 50 $ 100 $ Others _____
2. One gift of $ _______(those wishing to utilize automatic monthly withdrawals please fill out the section below)

Name_________________________________________
Address _____________________________________________________________
____________________________________________________________________

E-mail _________________________ Phone # ______________________________

Authorization

I hereby authorize Project G.I.F.T. to withdraw regular monthly donations from my account in the amount of:

$ _________ beginning the 15th day of ________ 20____

Bank account number : _____________ Type of account : Chequing Savings
Signature : ____________________ Bank name: ________________
Bank Address : _______________________________ City: ______________________
Prov: ______________________ Postal Code: _______________________

Important : Please attach a blank cheque marked VOID
This authorization can be cancelled at any time

please send form to:

Project Gift
4778 Victoria Ave.
Montreal, Quebec
Canada
H3W 2N1

Send money directly using PayPal