Events Payment Form

*Denotes Required Field * Title

This form is to be completed for event payments to FEB Central Ministries.

Personal Information

* First Name

* Middle Initial

* Last Name

* Street Address

* City

* Province

* Postal Code

* Phone Number ( ) -

* Email

Please indicate what event the payment is for.

Payment 1:

Amount $

Payment 2:

Amount $

Payment 3:

Amount $

* Total: $

E-Transfer

Please use the email address: accounting@febcentral.ca to set up your e-transfer.

E-Transfer Password:

Cheque

Please Make Payable To: FEB Central.

In The Memo Designate What The Payment Is For.

Mail to: FEB Central 175 Holiday Inn Drive Cambridge, On N3C 3T2

Credit Card

Type

Card Number

Expiry Date

Security Code (3 digits on the back)

* Date

* Signature

Use your finger or mouse to sign in this box.