WATOTO : Credit Card Payment Form

Personal Information

IMPORTANT NOTE: The Canadian Revenue Agency does not allow a person to donate money and have a tax receipt issued to a different person. For more details please visit http://www.cra-arc.gc.ca/chrts-gvng/chrts/plcy/cpc/cpc-010-eng.html

First Name : *

Last Name : *

All Correspondence will be sent to this address

Email :

Mailing Address: *

City : *

Postal Code : *

Province: *

Phone Number: *

Mobile/Work:

Credit Card Information

Name on Card: *

Credit Card Number: *

Expiration Month: *

Expiration Year: *

Security Code: *

Please Specify Frequency of your Payments: *

Monthly Recurring

Annual Recurring

Can we recoup any missed monthly contributions with your next payment? (applicable to monthly contributors only):

Yes

By continuing you agree to the Terms & Conditions and authorize Watoto Canada to deduct this and future recurring donations from the Bank Account/Credit Card you have supplied. Recurring donations will continue unless Watoto is contacted to discontinue: *

Agree

Leave this field blank: