MASJID-E-SALIHEEN MOSQUE PROJECT by yCtutf

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									ANJUMAN-E-ANWARUL ISLAM OF MALTON
                               (MASJID-E-SALIHEEN)

                                    PLEDGE FORM
I am sending my monthly PLEDGE of:

         $ 50              $ 100             $ 125              Other $ ___________________


         Cash. Please complete Section A.             Post-dated Cheques. Please complete Section A.


         Direct Deposit. Please complete sections A and B below.

                                               SECTION A

PERSONAL INFORMATION

Name: ______________________________________________________________________________

Address: ______________________________________________________________________________

City: ______________________ Province: ______________________ Postal Code: _________________

Contact # (s): ___________________________________________________________________

                                                SECTION B

BANKING INFORMATION (DIRECT DEPOSIT)
                  st
Staring with the 1 / 15th (Select one) day of ______________________

“I am giving my permission to Anjuman-E-Anwarul Islam of Malton (Masjid-E-Saliheen) to withdraw
from my Bank Account the pledge I have indicated above.

I will also notify the payee in writing of any changes in the account information of this authorization two
weeks prior to the net due date of the pre-authorized debit.


Bank Name: __________________________________________________________________________

Account Number: ______________________________ Bank Transit Number: _____________________


Signature: _____________________________________ Date: __________________________________

Mailing Address:                                                Cheque Payable to:
Anjuman-E-Anwarul Islam of Malton                               Anjuman-E-Anwarul Islam of Malton
7205 Goreway Drive, P.O.Box 59078                               The Toronto-Dominion Bank
Mississauga, Ontario, L4T 4J1                                   Institution #: 004
Tel. #s: (647) 618-9241 or (905) 671-2798                       Branch #: 18622
Email: masjidesaliheen@rogers.com                               Account #: 06970000336(CAN)

Note: For timely delivery of your tax receipt, please notify us of any changes in your mailing address.

              PLEASE RETURN FILLED FORM TO BR. SADIQ GANGAT.
       ANY QUESTIONS or ASSISTANCE? PLEASE CONTACT HIM AT NUMBER ABOVE.

								
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