Authorization Agreement for Automated Giving

Authorization Agreement for Automated Giving
Contact Information
Name*

First NameLast Name
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Automatic Payment Options
I wish to make my investment for weGive365 in the following way:*

Annual investment of $365. I will mail a check to Rochester Area Foundation at 12 Elton Hills Dr. NW, Rochester, MN 55901.Quarterly investments of $91.25. Please enroll me in automated giving with withdrawals reoccurring every February, May, August, and November.Monthly investment of $30.45. Please enroll me in automated giving with withdrawals reoccurring every month.
I/we hereby authorize the ROCHESTER AREA FOUNDATION to initiate debit entries to (indicate below) the depository financial institution and to debit the same to such account.*

My/our personal checking accountMy/our savings account
Bank Name
Bank Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Routing Number
Account Number
I/we acknowledge that the origination of ACH transactions to my/our account must comply with the provisions of U.S. law. If your account is closed or your electronic withdrawal is rejected, you will be notified by the Rochester Area Foundation. You may cancel or change electronic withdrawal of donations by notifying the Rochester Area Foundation at least three days in advance of the next scheduled transaction.*

I Agree
Understanding of Online Communication & Participation
I understand and accept that all weGive365 communication will be conducted via email, including voting for grant awardees. It is my responsibility to check my email in a timely manner if I wish to participate.*

Yes, I understand
Signature*

Clear
Should be Empty:

Authorization Agreement for Automated Giving

Contact Information

Automatic Payment Options

Understanding of Online Communication & Participation