Step 1 of 2 50% 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 NumberRouting NumberCredit Card Visa MasterCard American Express Discover Name on Card as it appears Card NumberExpiration Date CVV CodeMonthly ContributionMonthly 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.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
