Automatic Withdrawal Form

Jewel Warrior Monthly Support Form

with Camp David International
Thank you for becoming a monthly partner with Jewel Warriors- which is a branch of Camp David Interntional. You are part of a movement that is bringing life and hope to women, both in the USA and all over the world!

Please fill our the form below and your monthly support will begin the first support date after your submission.

Gratefully,

Grace Smith and Jewel Warriors
Name*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I would like to give this amount monthly:*
I would like to designate my support to:*

Jewel WarriorsOther
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
Bank Name*
Bank Branch*
City, State
Account Number*
Usually between 9 and 12 numbers - no spaces
Type of Bank Account*

Personal CheckingPersonal SavingsBusiness CheckingBusiness SavingsOther
Bank Phone Number

Area CodePhone Number
Date*

MonthDayYear
Date
Signature*

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

Jewel Warrior Monthly Support Form