ACH Authorization Agreement

DIRECT PAYMENTS (ACH DEBITS)

I (we) hereby authorize Beyond26 (501c3 tax ID 82-4828983), hereinafter called the Company, to debit entries to my (our) account indicated below and the Financial Institution named below, hereinafter called the Financial Institution. I (we) acknowledge the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

This authorization, if recurring, is to remain in full force and effect until the Company has received written notification from me (or either of us) of its termination in such time and manner as to afford the Company and the Financial Institution a reasonable opportunity to act on it.

Donation Type(Required)

Donation Amount(Required)

How Often Would You Like to Donate?

Beginning Date

I would like to dedicate my donation in memory or in honor of someone.

No, thank you.

Yes.

Dedication Type

In honor of...

In memory of...

Honoree's Name

First Last

Optional Communication

Communication Method

No, thank you.

Send email.

Send printed card in the mail.

Recipient's Name

First Last

Recipient's Email

Recipient's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Your Message to the Recipient

Please spell check, include how you would like your name(s) signed, mention the amount if desired, and format your message as you would like it delivered.

Account Details

Financial Institution(Required)

Account Number(Required)

Account Type(Required)

Routing Number(Required)

Account Holder Name(Required)

Authorization

Name(Required)

First Last

Organization Name

Phone(Required)

Email(Required)

Date(Required)

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ACH Donation Form

ACH Authorization Agreement

DIRECT PAYMENTS (ACH DEBITS)

Optional Communication

Account Details

Authorization

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