Fill in the online debit Order form below.Donation Form (#10)Fillup this form to add to our doner list. Your NamePhoneEmailBankAccount NumberAmount you would like to donateOn which day should the debit order run? 15th 30thType of Account? Cheque Savings TransmissionHow repeatedly do you want to donate? One Time Monthly YearlyI/We hereby authorize you to draw against my/our account with the above-mentioned bank (or any other bank or branch to which I/We may transfer my/our account) the amount necessary for the payment of the monthly/quarterly/annual commitment due in respect of the installment/premium as agreed. All such withdrawals from my/our bank account by you shall be treated as though they had been signed by me/us as personally.I/We understand that the withdrawals hereby authorized will be processed by computer through a system known as the BankServ Magnetic Tape Service and I also understand that details of each withdrawal will be printed on my bank statement of on an accompanying voucher.I/We agree to pay any bank charges relating to this debit order instruction.This authority may be canceled by me/us by giving you thirty days' notice in writing, sent by prepaid registered post, but I/We understand that I/We shall not be entitled to any refund of amounts which you have withdrawn while the authority was in force if such amounts were legally owing to you.Assignment:I/We acknowledge that Anchor of Hope Ministries hereby authorized to effect the drawing(s) against my/our account may not cede or assign any of it’s rights to any third party without my/our prior written consent and that I/we may not delegate any or my/our obligations in terms of this contract/authority to any third party without prior written consent of the authorized party. Receipt of this instruction by you shall be regarded as receipt thereof by my/our bank (whichever it is or will be)Checkbox if you agree to the above Yes I agreeI consent to have this website store my submitted information so they can respond to my inquirySubmit