GenesisCare Employee Relief Fund

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Credit/Debit Card

Bank Transfer

First Name

Last Name

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This donation is on behalf of a company

Phone

Address

Address 2

Postal Code

City

State / Province

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By using Apple Pay, you will provide your name, e-mail and address.

By using Google Pay, you will provide your name, e-mail and address.

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

If you use RELIEF FUND DONATION’ services or purchase additional products periodically pursuant to RELIEF FUND DONATION’ terms, you authorise RELIEF FUND DONATION 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.

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You can log in to edit your recurring donation any time

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One-timeMonthlyQuarterlyAnnually