Fill out the form below to sign up for automatic monthly donations to benefit Al-Hijra Mosque.

First Name (required)

Last Name (required)

Street Address (required)

City (required)

Province (required)

Country (required)

Phone Number (required)

CellHomeWork

Donation Amount (required)
$5.00$10.00$15.00$20.00Other (please enter amount below):

Email (required)

Banking Information

A member of the mosque will contact you regarding your donation to gather your banking details. We will need:

  • Bank Number
  • Branch Number
  • Name of Financial Institution
  • Branch Name
  • Branch Address

Check here if you affirm that the above information is correct and truthful.

Need help finding your banking information?