ALA Entity Sign Up Form

Auxiliary Organization Name or Number
Please Incluce Unit, Department or Other Identifers as needed.
Employer Identification Number (EIN)
This Should Be Numbers Only, (9 total digits)
Department (State)
Designated Representative

Full NameTitle
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Secure Banking Information
Bank Name
Bank Account Type
Bank Routing Number
This Should Be Numbers Only, (9 digits)
Bank Account Number
This Should Be Numbers Only.
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Sign Up Authorization
Name

First NameLast Name
I certify that I am an authorized officer of this ALA entity, and that the banking information provided is accurate for the purpose of receiving donations.
Should be Empty: