General | crsok.org

First Name

Last Name

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Address

Address 2

Postal Code

City

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CARD BANK TRANSFER

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MM / YY

CVC Code

The 3-4 digits on the back of your credit card

Billing ZIP Code

Enter the Zip/Postal code for your credit card billing address

By clicking Donate, you authorise COUNSELING & RECOVERY to debit the bank account that you connect to for any amount owed for charges arising from your use of COUNSELING & RECOVERY ’ services and/or purchase of products from COUNSELING & RECOVERY , pursuant to COUNSELING & RECOVERY ’ website and terms, until this authorisation is revoked. You may amend or cancel this authorisation at any time by providing notice to COUNSELING & RECOVERY with 30 (thirty) days notice.

If you use COUNSELING & RECOVERY ’ services or purchase additional products periodically pursuant to COUNSELING & RECOVERY ’ terms, you authorise COUNSELING & RECOVERY to debit your bank account periodically. Payments that fall outside the regular debits authorised above will only be debited after your authorisation is obtained.

Bank Name

Account Type

Account Last 4

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