*

Yes! I'd like to sponsor a child with Home Free

Name *

First Name

Last Name

Street Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Option 1: Pre-authorized Debit (PAD)

Date:

MM

DD

YYYY

Yes, I will send a VOID Cheque

I may revoke my authorization at any time, subject to providing notice of 15 days. To obtain a sample cancellation form, or for more information on my right to cancel a PAD Agreement, I may contact my financial institution or visit www.cdnpay.ca. I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit www.cdnpay.ca.

Option 2: Credit Card

Date:

MM

DD

YYYY

I understand that my donations will continue automatically each month until I notify We Are Home Free of any change. I can change or cancel my monthly donation at any time.