Hope Builders Online Application

Your Name*
First Last
Spouse's Name (optional)
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Your Phone Number*
Spouse's Phone (optional)
Your Email*
Spouse's Email (optional)
Opt-Out
- We wish to be anonymous

Bank Draft
- Personal
- Business
- Checking
- Savings
Bank Name
Account Number
Routing Number
Credit Card
- Visa
- MasterCard
- American Express
- Discover
Name on Card as it appears
Card Number
Expiration Date
CVV Code
Monthly Contribution
Monthly Amount*
Date to Draft (Monthly)
Date of First Draft
MM slash DD slash YYYY
Authorization*
I authorize this transaction.
I hereby authorize Third Lens Corporation, a non-profit corporation, initiate entries to my banking account or credit card for my monthly donation to the ministry. This authority will remain in effect until I notify Third Lens Corporation of changes via email (donate@third-lens.org) or mail. I understand that it may take approximately ten (10) days for payments to take effect, whether initiation, change or cancellation.
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Name
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Monthly Contribution