Bank Draft Form

In which month would you like to make or begin your donation? *

January

February

March

April

May

June

July

August

September

October

November

December

Address *

Specific Ministry *

Checking account number *

Is this a recurring or one-time gift? *

One time

Monthly

Quarterly (Four times a year)

Annually

Donation Amount *

Please select the day of the month on which we should draft your account. (If your gift is recurring, this will remain the same for each month unless you call the office to change it.) *

First of the month

Fifteenth (15th)

Twenty-fifth (25th)

Name: *

Name on account *

Email: *

Phone *

Routing number *

Zip/Postal code *

Digital Signature - (By writing my name below, I authorize Global Outreach to automatically deduct the given amount from my checking account on the selected date, either one-time or recurring, as specified herein. I understand that I may terminate or change this agreement at any time by calling or providing written notice to Global Outreach International.) *