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Authorization Agreement for Direct Debit Gifts
Please print this form, then mail a completed copy to your banking institution, as well as a copy to CARE to activate a direct debit (or electronic funds transfer) gift.
I (We) hereby authorize the Corfu Animal Rescue Establishment to initiate debit entries to my (our) checking/savings account indicated below at the depository named below. I (We) authorize scheduled debits to the account below for the following amount:
Monthly on the first day of the month _____________
Quarterly on the first day of the quarter _____________
Annually on the first day of the year _____________
Date of first authorized debit entry: ___/01/___
Date of last authorized debit entry: ___/01/___
The gift is to be applied as follows: Annual Fund ________
Other ________ (Please specify:________________)
Depository Name and Branch__________________________ For verification
City _____________________ Country ______________ purposes, please
Depository 9-Digit Routing Number _____________________ attach a deposit slip
Name(s) of Account Holder(s)__________________________ or void check to this
Account Number____________________________________ form.
Account Type _____Checking ______Savings
This agreement is to remain in effect until the Corfu Animal Rescue Establishment and my (our) depository have received written notification from me (or either of us) of its termination in such time as to afford the College and my Depository a reasonable opportunity to act on it.
Authorization Signature(s) ______________________ Date_______
___________________________________________ Date_______
Thank you!
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