Direct debit authorisation

If you wish to support our work financially, you can give us a direct debit authorisation by using this page. As soon as you click on the box "Send", the content is sent to us by e-mail. If this procedure is not secure enough for you, you can fill in the page on the screen, then print it and send it to us by fax or letter. Thank you in advance for your support. You are helping us to help others.

Direct debit authorisation
I/we herewith grant you revocable authorisation to collect the following payments which are payable by me/us by direct debit:

Name of the bank :
Bank code:
Account number:
Account holder:
Amount (EUR):
Designated use:
Number of bookings:	One single amount Monthly, on the of each month every months, on the of each month Annually, on the

Personal data

My/our mission friend's number is:

Title:
Name:
Name, line 2:
Street/post box:
Post code/place:
Country:
Email:

EBM/MASA - European Baptist Mission in Africa - Latin America - India

Pages of this rubric

Direct debit authorisation