Kindness for Kids-Registration | Shelter From the Storm Ministries, Inc.

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Authorization Agreement for Checking or Savings Account ACH Debits

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I (we) hereby authorize Shelter from the Storm Ministries, Inc. (SFTSM), to debit entries to my (our) account indicated below at the depository financial institution named below, hereinafter called Financial Institution, and to DEBIT the amount listed below to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

Checking or Savings Account? (Please allow 5 to 7 business days for us to verify your account & process your donation)

Personal or Business Account?

Financial Institution

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Routing Number

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Name

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Last

Name 2

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Last

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Name 3

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Last

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Name 4

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Last

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Address

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Address Line 2

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Signature

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Today's Date

Thank you for registering for Kindness 4 Kids. Please check in at the registration table when you arrive. This authorization will remain in effect until it is terminated and instructions changing the payment method are received. Revocation may be orally by calling 608-516-8023 or by emailing: michelle.hanley@sftsm.org. Notification must be at least 14 business days prior to the scheduled transfer.

I agree