Fundraising Mandate Agreement Form

Fundraising Mandate Agreement Form
Complete this form to set up a fundraising mandate agreement and provide the information needed to authorize the mandate.
Supporter Information
Full Name
First NameMiddle NameLast Name
Organization Name (if applicable)
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Fundraising Mandate Details
Campaign or Cause Name
Fundraising Amount or Target Amount
Mandate Start Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preferred Frequency
Other
Agreement and Authorization
Mandate Authorization Statement
I agree to the mandate terms and authorize the fundraising activities described in this form
Should be Empty: