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    Foundation Bank Draft and Credit Card Authorization Form

    Uploaded by

    Josh A. Krycerick
    This document is a bank draft and credit card authorization form for making monthly donations to the NACA Foundation. It requests the donor's contact information and signature to set up either a monthly bank draft from their checking account or a monthly credit card charge. The donor specifies the amount to be donated each month, and the starting and ending months for the donations. By signing the form, the donor authorizes NACA to automatically charge the designated bank account or credit card on a monthly basis for their donation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Foundation Bank Draft and Credit Card Authorization Form

    Uploaded by

    Josh A. Krycerick
    14 views1 page
    This document is a bank draft and credit card authorization form for making monthly donations to the NACA Foundation. It requests the donor's contact information and signature to set up either a monthly bank draft from their checking account or a monthly credit card charge. The donor specifies the amount to be donated each month, and the starting and ending months for the donations. By signing the form, the donor authorizes NACA to automatically charge the designated bank account or credit card on a monthly basis for their donation.

    Original Title

    Automatic Bank Draft

    Copyright

    © Attribution Non-Commercial (BY-NC)

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    This document is a bank draft and credit card authorization form for making monthly donations to the NACA Foundation. It requests the donor's contact information and signature to set up either a monthly bank draft from their checking account or a monthly credit card charge. The donor specifies the amount to be donated each month, and the starting and ending months for the donations. By signing the form, the donor authorizes NACA to automatically charge the designated bank account or credit card on a monthly basis for their donation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    14 views1 page

    Foundation Bank Draft and Credit Card Authorization Form

    Uploaded by

    Josh A. Krycerick
    This document is a bank draft and credit card authorization form for making monthly donations to the NACA Foundation. It requests the donor's contact information and signature to set up either a monthly bank draft from their checking account or a monthly credit card charge. The donor specifies the amount to be donated each month, and the starting and ending months for the donations. By signing the form, the donor authorizes NACA to automatically charge the designated bank account or credit card on a monthly basis for their donation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Foundation Bank Draft and Credit

    Card Authorization Form


    Thank you for your support of the NACA Foundation. Please provide the following information to set
    up a monthly bank or credit card draft and fax this completed form to Erin Wilson at the NACA Office
    at (803) 749-1047 or mail it to NACA Foundation 13 Harbison Way Columbia, SC 29212-3401.
    Name: ______________________________________________________________________________________
    Address: ____________________________________________________________________________________
    City: __________________________________________ State: ___________ Zip: _____________________
    Phone: _______________________ Fax: _______________________ E-mail: ___________________________
    Bank Draft Information
    To set up a monthly bank draft please attach a cancelled check from the account from which you
    wish to have the donation drafted and complete the following information:
    Total amount to be drafted each month: ______________________ (minimum of $15)
    Month you would like your contributions to begin: ___________________________
    Month you would like your contributions to end (or please mark on-going): _______________________
    Signature: _______________________________________________________ Date: _____________________
    Credit Card Draft Information
     Visa
    Check one:

     MasterCard

     American Express

    Card number: _______________________________________________________________________________


    Expiration date: __________________ Three Digit Code on Back of Card (four digits for AMEX): ______
    Name as it appears on the card (please print): __________________________________________________
    Billing address (if different from above): _______________________________________________________
    To set up a monthly credit card draft, please complete the following section, or to make a one-time
    gift to the NACA Foundation, please indicate the amount here: __________________________
    Total amount to be drafted each month: ______________________ (minimum of $15)
    Month you would like your contributions to begin: ___________________________
    Month you would like your contributions to end (or please mark on-going): _______________________
    Signature: ______________________________________________________ Date: ______________________
    By completing and signing this form, you authorize NACA to draft the bank account or charge the credit card indicated above for contributions to the NACA Foundation. Should your bank draft or card credit card be declined for any
    reason, we will notify you as soon as possible. NACA will keep this form on file until the authorized bank or credit
    card draft discontinues or until the expiration date listed on the credit card. When the expiration date on the
    authorized credit card has passed, you will be asked to complete a new form. Should you have any questions,
    please contact Erin Wilson at (803) 217-3473.

    5077 JJ 03/09

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