// Welcome to the National House of Prayer - Bienvenue sur la Maison Nationale de Prière //

Partner Form

Title *
First Name *		Last Name *
Address *
City *		Province/State *
Country *		Postal Code *
Telephone (Daytime) *
Telephone (Evening) *
Email *

Monthly Donation Amount
Other Monthly Amount
	Monthly donations will be processed until we are otherwise notified. If you wish to donate for a specified period, please indicate an end date in the comments box below.
One-time Donation Amount
Other One-time Amount
	Please note that tax receipts will be issued for all donations after the end of the year.
Credit Card Type *
Credit Card Number *
Expiration Date *
Name on Card *
Funds Designation *
Comments	By pressing Submit, I hereby authorize the National House of Prayer to charge my credit card with the amount(s) designated on this form.