Electronic Funds Transfer (Eft) Authorization Form
Download a blank fillable Electronic Funds Transfer (Eft) Authorization Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Electronic Funds Transfer (Eft) Authorization Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Electronic Funds Transfer (EFT) Authorization Form
Yes, I want to save time & money in supporting the National Ataxia Foundation through EFT.
Fill out & mail or fax form with a Voided Check or for savings acco unt a voided deposit slip to:
National Ataxia Foundation
Attn: Finance Dept
600 Hwy 169 S, Ste 1725
Minneapolis, MN 55426
FAX-763-553-0167 Attn: Finance Department
Personal Information (*required fields)
*Name on Account:
*Address:
*City:
*State:
* Postal Code:
*Country:
Email:
*Phone:
Gift Information
*I Authorize the National Ataxia Foundation to deduct from my
Checking
Savings account.
One Time Charge of
$
(one time amount Authorized)
th
Monthly
5
of each month
$
(Monthly amount authorized)
($10.00 a month minimum)
th
Quarterly
5
of March, June, Sept & Dec
$
(Quarterly amount authorized)
($30.00 a quarter minimum)
Notes:
(Designate Gift Towards)
Bank Information
*Financial Institute:
*City:
*State:
*Phone:
*Routing Number:
*Account Number:
By signing this form, you authorize the National Ataxia Foundation to instruct your financial institute to debit
your account as directed. This deduction will remain in effect until you chose to cancel giving 15 days written
notice or by submitting an updated EFT authorization form if any information changes. Your gift will appear
on your bank statement automatically. Each January you will receive a statement from NAF showing the
amount you have donated through our EFT program during the calendar year (January-December).
Save the statement for tax documentation.
*Account Owner Signature
(required)
*Date
The National Ataxia Foundation is a 501 (C) (3) non-profit organization, our Federal Tax ID # is 41-0832903. All
donations to NAF are tax deductible to the extent allow by law. Phone: 763-553-0020
Please keep a copy of this authorization form for your records & Thank You.
Date Received:
Date Initiated:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business