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.
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

Monthly Contribution