University
of Puget Sound
Office
of University Relations
Advancement
Services
1500
North Warner Street
Tacoma,
WA 98416-0067
(253)
879-2662
Thank you for inquiring about
our Electronic Funds Transfer charitable contribution program. By completing and returning this form, you
will be on your way to establishing an easier and less costly way of making
your gift to Puget Sound. This
notification to draft your account on or about the 10th of each month will
remain in effect until we have received written notification from you of its
termination, and the University of Puget Sound has had reasonable opportunity
to act on it. Your monthly bank
statement will identify this draft when it occurs.
You should anticipate the first
draft approximately 30-45 days after we have received your authorization.
I (we) hereby authorize the
University of Puget Sound to initiate debit entries to my (our) bank account indicated
below and the financial institution named below, to debit the same to such
account.
FINANCIAL
INSTITUTION BRANCH
CITY STATE ZIP ACCOUNT TYPE: r
Checking r
Savings
TRANSMIT/ABA
NO. (Omit if uncertain) ACCOUNT NO.
AMOUNT TO DEBIT PER MONTH (Will
occur on or about the 10th of each month)
$
This authority to remain in
full force and effect until the University of Puget Sound has received written
notification from me (or either of us) of its termination in such time and in
such manner as to afford the University of Puget Sound a reasonable opportunity
to act on it.
NAME(S) PHONE #
(PLEASE PRINT)
DATE SIGNED X SIGNED X
PLEASE
ATTACH VOIDED CHECK HERE