Syria Emergency Appeal

CARD PAYPAL BANK TRANSFER

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MM / YY

CVC Code

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

If you use MEDGLOBAL, INC.’ services or purchase additional products periodically pursuant to MEDGLOBAL, INC.’ terms, you authorise MEDGLOBAL, INC. 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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