Donation | Front Line Defenders

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Une fois Mensuelle

Type of payment of your donation:*

Carte de Crédit Bank Account / Direct Debit

Informations personnelles (indiquez votre adresse telle qu’elle apparaît sur votre carte de crédit ou votre compte bancaire)

Prénom et Nom *
Adresse 1 *
Adresse 2
Ville: *
Code postal:
Pays *
Téléphone (domicile/professionnel):
Téléphone portable:
E-mail: *

Informations sur votre carte de crédit: *

Titulaire de la carte: *
Type de carte: *
Numéro de carte: *
Date d’expiration: *	Mois / Année
CVV (3 digit code on the back of your card): *

Bank Account / Direct Debit

Please note that direct debit is only available for euro zone countries.
Account number (IBAN): *
SWIFT/BIC: *
Is your bank account a Republic of Ireland bank account: *	Yes No
Is more than one signatory required to sign on your account: *	Yes No
Can your bank account accept Direct Debit: *	Yes No

Do you pay taxes in Ireland?: *	Yes No The Irish Government can increase value of donations of €250+ in a year by 45% if you pay income tax in Republic of Ireland.

I would like Front Line Defenders to keep me up to date about the work it is doing for human rights defenders at risk via:
	Post, Email, Phone, SMS.
What prompted you to donate today?:
Entrez les 4 lettres suivantes: dans le cadre Les lettres peuvent être indifféremment en minuscule ou en majuscule. Si vous ne parvenez pas à lire les lettres, actualisez la page.

Les champs marqués du symbole sont obligatoires.*
Your information is secure: You are sending your information to the Front Line Defenders server over an encrypted (https) channel. We store all personal information on our protected internal server in PGP/GPG encrypted format.

Legal Text:
Front Line – The International Foundation for the Protection of Human Rights Defenders
2nd Floor, Grattan House, Temple Road, Blackrock, Co. Dublin
+353 1 212 3750
Creditors Identifier No. IE20ZZZ360512

Please note that as you have signed up online and have not signed a paper mandate, you authorise (A) Front Line Defenders to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instruction from Front Line Defenders.

As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can receive from your bank.