Authorization to Establish Recurring Donations to University of Puget Sound

Office of University Relations Information Services
1500 North Warner Street
Tacoma, WA  98416-1067
(253) 879-3603

 

Thank you for your interest in supporting University of Puget Sound through our Electronic Funds Transfer (also known as E-check, EFT, or ACH) 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 bank account 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 will occur within 30 days of our receipt of your signed authorization form.

AUTHORIZATION AGREEMENT FOR PRE-AUTHORIZED DRAFTS

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:       Checking           Savings

 

TRANSMIT/ABA NO.                                                        ACCOUNT NO.                                                          

 

AMOUNT TO DEBIT PER MONTH  $                                    DATE OF DEBIT: The               of each month.
                                                                                   (We will debit the account as close to this date as possible.)

DESIGNATION OF GIFT:                                                                                                                                    

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)                                                                                                                                                
(PLEASE PRINT)

PHONE #                                                                DATE                                                              

SIGNED X                                                               SIGNED X                                                        

 

Please print and mail this form to:                          Optional: Microsoft Word version of form: EFT Form.doc
University of Puget Sound
1500 North Warner St., CMB 1067
Tacoma, WA  98416-1067