Direct Debit Donations

Initials

Name

Address

Postal / zip code

Place

Phone

Date of birth

Email

I hereby authorize the Heliconia Scholarship Foundation to, until further notice, debit the following amount from my bank account

every monthonce

Your donation amount in €

Your IBAN

I have hereby read: (please check)

● We handle your personal information with care and will not use it for marketing purposes or provide it to third parties
● By signing this form, you agree to the legal terms of direct debit. You can reverse your contribution up to 56 days after the debit date
● Cancel your donorship? Please send your request with your contact details to us by e-mail or letter. The processing period for withdrawing your authorization is a maximum of 30 days
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