Restoring Hope One Child at a Time

Business Name

DUCF

 

 

AUTOMATIC CHECKING ACCOUNT

TRANSFER AUTHORIZATION

 

 

PLEASE PRINT

 

Name as it appears on bank account                                                 

 

Please make monthly transfers on:   (choose one) □ 5^th              □ 20^th

                                

Billing address ____________________________

 

City ________________________  State _____   Zip________

 

Telephone # ____________________________             

 

email address _________________________

 

Sponsored Child’s Name                        child #                Monthly Amt.

 

___________________________     __________           __________

 

___________________________       __________          __________

 

                                            Total Monthly Transfer:        __________

 

 

I hereby authorize my bank to electronically transfer the amount

shown above to Dove Uganda Children’s Fund on the date

indicated. I understand that I may cancel or change this arrangement

at any time by notifying Dove Uganda Children’s Fund in writing.

 

Signature _________________________________        Date signed _______________

 

Return this form along with a voided check to

Dove Uganda Children’s Fund, PO Box 382, Princeton, IL  61356-0382

Phone: (815) 879-8616    Fax: (815) 879-8616    email: linda@ducf.org

 

We will send you a confirmation notice indicating when the first transfer will take place.