ACH Donation Form

We invite you to join us in seeking the pleasure of Allah ﷻ. Whether through prayer, learning, or serving the community, may we all strive for sincerity and righteousness.

ACH Donation Form

Personal Information

The information given in this section is considered as the information of the primary account owner information.

First Name

Last Name

Phone Number

Preferred Contact Method

Phone Email Mail

Billing Address

City

State

Postal/ Zip Code

Country

Account Information

Bank Name

Account Type

Account Number

Routing Number

Donation Amount

Amount

Frequency

Agreement

By accepting this form, I acknowledge that the information I've given in this form is accurate and I agree to all the terms and conditions.

By accepting this form, I authorize Masjid Al-Haqq, under the Proclaim Truth Charitable Trust, to debit the amount entered above from my bank account on the date entered in this form. This authorization will remain in effect until I provide written notice to cancel.

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Agree

Full Name

Date