By Bank Transfer – LFAN Donations

Please enter your information below. PLEASE NOTE that all fields marked with (*) are required

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Type of Donation*
Donation Amount*
#1 - Bank Name*
#2 - Transit Number (5 digits)*
#3 - Institution Number (3 digits)*
#4 - Account Number*
Donation Start Date*
MM slash DD slash YYYY
Special Instructions / Notes
For example: "Mission Trips" or any other specific designation.
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