Form

Autodraft Donation Form

I understand that all autodrafts occur on the 15th of the month. *

Yes
Name *

First Name Last Name
If different, name(s) on bank account
Amount of monthly donation $ *
Fund
Please describe how you
want to allocate your gifts
Which committee?

Address *

Street Address
Street Address Line 2
City	State
ZIP Code	Country

E-mail *

Confirmation Email
Phone number

- Area Code Phone Number
Name of Bank *
Type of account *
*Required fields
Should be Empty: