BGCOLC ACH Authorization

Boys & Girls Club of Livingston County

One-time & Recurring Gifts Form
Thank you for considering a contribution to Boys & Girls Club of Livingston County! If you have any questions or concerns, please contact Resource Development Manager Carmen Gentes at cgentes@bgclivingston.org or CEO Jodi Martin at jmartin@bgclivingston.org. Both can also be reached at 815-842-3089. We appreciate you!
Name*

First NameLast Name
Email*
example@example.com
Name(s) on Bank Account*
Bank Name*
Bank Branch*
City, State
Routing Number*
must be 9 numbers - no spaces
Account Number*
must be 9-12 numbers - no spaces
Account Type*
Donation Amount*

prevnext( X )
USD
Giving Frequency

One-time GiftMonthly Gift (I would like to give the above specified amount each month)Quarterly Gift (I would like to give the above specified amount each quarter)
Signature*

Clear
Enter the message as it's shown*
Thank you for supporting Great Futures!
Should be Empty:

Boys & Girls Club of Livingston County