Automatic Withdrawal Form

Yes! I want to sponsor a child for summer camp on a monthly basis! I commit to pray for my camper throughout the school year.
Monthly Giving Levels (Check ONE)

Campfire Level - $25 per month (Hero of Hope bumper sticker)Hammock Level - $50 per month (Coffee mug and camper prayer card)Cabin Level - $100 per month (T-shirt and camper prayer card)Wagon Circle Level - $200 per month (Polo shirt and camper prayer card)Fort Level - $300 per month (Jacket, camper prayer card, name plaque on donor tree)Trail Master Level - $10,000 or more in a single year via Endowments, Capital Projects, Corporate Sponsorships, and in-kind donations. (Jacket, name plaque on donor tree, name on website)
Choose how to give:

Automatic Monthly Withdraw (our preferred method)Mail a check each month to Hope of the Ozarks 11305 Private Drive 5316 Rolla MO 65401Credit Card
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
For Automatic Monthly Withdraw
I would like to have this automatically debited from my account on the:

1st of the month15th of the month
Name(s) on Bank Account (business name if used)
Routing Number
must be 9 numbers - no spaces
Account Number
must be 9-12 numbers - no spaces
Bank Name
Bank Branch
City, State
Type of Bank Account

Personal CheckingPersonal SavingsBusiness CheckingOther
Bank Phone Number

Area CodePhone Number
Date*

MonthDayYear
Date
For Credit Card
Name as it appears on card:
Card Number:
Exp Date:
CVC Code:
Shirt Size
Signature*

Clear
Enter the message as it's shown*
Should be Empty:

For Automatic Monthly Withdraw

For Credit Card