Donation Form 2 | Access and Information Network

First Name

Last Name

Choose your country

Address

Address 2

Postal Code

City

State / Province

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Please fix the errors above.

CARD PAYPAL BANK TRANSFER

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

If you use AIDS INTERFAITH NETWOR’ services or purchase additional products periodically pursuant to AIDS INTERFAITH NETWOR’ terms, you authorise AIDS INTERFAITH NETWOR 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.

Create a donor account to manage my donations and donate again faster.

Optionally add to cover processing fees

You can log in to edit your recurring donation any time