HHA program helping patients recover at home. | PURE AID INCORPORATED

CARD PAYPAL BANK TRANSFER Direct Debit

Card Number

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

If you use PURE AID INCORPORATED’ services or purchase additional products periodically pursuant to PURE AID INCORPORATED’ terms, you authorise PURE AID INCORPORATED 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

Donate from your bank using Plaid, a secure and encrypted bank transfer service.

Bancontact

You didn't choose the bank name.

By providing your payment information and confirming this payment, you authorise (A) PURE AID INCORPORATED and Stripe, our payment service provider, to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with those instructions. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank. You agree to receive notifications for future debits up to 2 days before they occur.

iDEAL

SEPA Debit

IBAN

In compliance for SEPA Direct Debit network regulations the following billing address fields are mandatory.

Billing Address

Billing City

Billing Postal Code

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