Pre-Authorized Payment Form

I/We do hereby authorize "Toronto Durgabari" to process a debit, in paper, electronic or other form in the amount of the donation on my/our account in the 2nd week of each month beginning from _________ as detailed to me/us on a statement mailed to me/us from time to time.

I/We do hereby authorize "Toronto Durgabari" (Payee) to draw the above mentioned amount from my bank A/C every month. My/Our VOID CHEQUE is attached herewith for further procedure.