Darul Arqum

Membership Form

First Name

Last Name

Phone

Amount of Monthly Donations

How you want to pay?

For monthly payments through credit card or if you do not want to share your bank information click donate link, enter an amount $20 or more and check the box "Make this monthly donation" using your paypal account.

Please enter you banking information in the following fields to setup monthly subscription/ membership.

NOTE: For monthly recurring payments using "Donate" button you need a paypal account, however, you can choose to make one time payment for 12 months membership using card and email to with details.

Do not forget to press SUBMIT button after completing the form.

Name of your Bank

Institution #

Transit #

Account #

VIOD Check Image

Upload (Max 15MB)

Day of the month you want us to charge your Credit Card/Bank Account:

Complete Address (we can't issue any Tax Receipt without your complete address)

Signature (Type your full name below)

I authorize "Darul Arqum" to collect above mentioned amount from my Credit Card/Bank Account

CRA Approved Charitable Organization

Charitable Reg. # 709549687RR0001

Ontario STAY AT HOME Order

Public Health Ontario Page for COVID-19

Government of Canada Page for COVID-19

Signature (Type your full name below)