STEP 2 (recurring contribution) CONTACT INFORMATION  * required fields *First Name: *Last Name: *Address: *City/Town: *Prov: *Postal Code: *Phone: Email: Company STEP 3 RECURRING CONTRIBUTION INFORMATION FIRST CONTRIBUTION *Please enter the amount you wish to contribute today in dollars and cents... (This is the amount you want charged to your card today. It can be different from the amount of your recurring contribution. For example, if you want to contribute $100 by donating $50 today and $10 for another five months, you would put $50 in the box to the right and $10 in the box below. )  $ (Enter amount in dollars and cents without a $ sign. Example: 100.00) ALL RECURRING CONTRIBUTIONS *Please enter the amount you want your future recurring contributions to be (in dollars and cents)... (The amount of your recurring contribution can be the same or different from your initial contribution. $ (Enter amount in dollars and cents without a $ sign. Example: 100.00) *How often do you wish to make this recurring contribution? (You can schedule your recurring contribution to be made on a daily, weekly or monthly basis)  Choose one MonthlyWeeklyDaily *How many many recurring contributions do you wish to make? (Choose the number of recurring contributions you wish to make. This does not include your first contribution. For example, if you want to contribute $100 by donating $20 today and then $10 a month for another 8 months, you would choose to make 8 recurring contributions.) Number of contributions1 contribution2 contributions3 contributions4 contributions5 contributions6 contributions7 contributions8 contributions9 contributions10 contributions11 contributions12 contributions24 contributions26 contributions52 contributions *When should your first recurring contribution be charged to your credit card? (Your initial payment will be processed immediately. Your first recurring payment will be made on the date you enter to the right. Enter date in this format YYYY/MM/DD.) YYYY/MM/DD STEP 4 OUR GUARANTEE The Citizens Centre for Freedom and Democracy does not sell, share, rent or in any other way disclose the personal information or email addresses of it supporters.