1. Donation Details

  2. First Name *
    Please let us know your first name.
  3. Last Name *
    Please let us know your last name.
  4. Spouse First Name
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  5. Spouse Last Name
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  6. Address *
    Please let us know your address.
  7. Suburb or Town *
    Please let us know your suburb.
  8. Postcode *
    Please let us know your postcode.
  9. State *
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  10. Phone Number *
    Please let us know your contact phone number.
  11. Email *
    Please enter a valid email address.
  12. Missionary or Ministry Name *
    Please let us know your Missionary or Ministry name.
  13. Missionary or Ministry Number *
    Please let us know your Missionary or Ministry number.
  14. Donation Amount

  15. Amount *
    Please let us know what you would like to donate in dollars (in numbers).
  16. Donation Type *
    Please let us know your preferred donation type.
  17. Giving Frequency *
    Please let us know your preferred giving frequency.
  18. Giving Start Date *
    Please select a date for your first payment.
    Must be AFTER Today's date
  19. End After *
    Please let us know your preferred giving frequency.
  20. Number of Payments *
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  21. Giving End Date *
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  22. Payment Method *
    Please let us know your preferred donation method.
  23. Last 4 numbers of your Credit Card *
    Please let us know the last 4 numbers of your Credit Card.
    To help Power to Change match your donation to the right Missionary or Ministry
  24. Last 4 numbers of your Bank Account *
    Please let us know the last 4 numbers of your Bank Account.
    To help Power to Change match your donation to the right Missionary or Ministry
  25. I/We hereby authorise Power to Change to increase the regular partnership amount by 5% annually. *
    Please let us know if you authorise CCCA to increase the regular partnership amount by 5% annually.

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