Monthly
Auto Debit Bank Program Foundation of Human Understanding • PO Box 1000, Grants Pass, OR 97528 Fax: 1-541-956-6705 • Email: [email protected]
The minimum monthly donation is $5.00. The amount you choose will be debited from your account on the 15th of each month. You can change the donation amount or cancel at any time by contacting the foundation:
click here to contact us.
3 Easy Steps
1. Complete the form below and then print.
2. Sign and date it.
3. Return the form to FHU with a "voided check" (write "void" across the check, this gives us the bank's details).
Name:
Address:
City:
State
Zip Code:
Telephone:
I (we)______________________________________ authorize the Foundation
of Human Understanding to initiate debit entries on the 15th of (month)_____________for
a monthly donation in the fixed amount of...
$200
$100
$75
$50
$25
$10
$5
other (enter amount)
...to my/our checking account. I (we) authorize my
(our) financial institution to accept debit entries initiated by the
Foundation of Human Understanding and to deduct the amount specified
above from my (our account). This authorization is to remain in effect
until the Foundation of Human Understanding has received written notification
from me (us) of its termination. I (we) understand that I (we) have
the right to stop payment of a debit entry by notification to the
Foundation of Human Understanding prior to charging my (our) account
up to 15 days following issuance of bank statement or 45 days after
the account is charged, whichever occurs first.
Account #________________________________
Name and Address of financial institution
Date:
Signature: _______________________________
How do you listen to Roy?
Radio Station (enter station call letters)
Web Site
Both
None
