AUTHORIZATION FOR PREAUTHORIZED PAYMENTS

Charitable giving is the bedrock of Viola's House. It was how we started and it is how we’ve grown so quickly in the last 2 years. And now, even in this difficult economic climate, it’s how we’ll continue to thrive. We rely on the generosity of individuals, corporations and foundations to continue our mission of providing health and hope to young, pregnant girls and women in crisis and at risk of being homeless.

Please complete form below to authorize payments to Viola's House

CONTACT INFORMATION
*Title
*First Name
*Last Name
*Address
*City
*State
*Postal Code
*Phone
*Email
CONTRIBUTION AMOUNT
*Enter Amount 0000 (only dollars / no cents)
DURATION AND FREQUENCY
*Please Select
Duration (Optional) Effective Date (mm/dd/yyyy)
Termination Date (mm/dd/yyyy)
Comment
*  New Authorization  Change to Authorization
FINANCIAL INSTITUTION (DEPOSITORY NAME):
*Routing Number
*Account Number
*Account Type  Checking  Savings
 
TERMS

My account will remain subject to its individual terms and conditions, which are not modified by this authorization. I acknowledge that the origination of these transactions must comply with the provisions of U.S. law.

I understand that this authorization will remain in full force and effect until the termination date stated above or until the COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford the COMPANY and the DEPOSITORY a reasonable opportunity to act on it.

ACCEPTANCE
I authorize Viola's House to initiate debit entries to my account, for the purpose of accomplishing the above preauthorized payments.

BY CLICKING ON THE "I AGREE TO TERMS" BOX, I UNCONDITIONALLY AGREE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE TERMS OF THIS AGREEMENT.

TYPE YOUR NAME HERE IN LIEU OF WRITTEN SIGNATURE:


CLICK TO AGREE AND SUBMIT




Sidebar Pic 11

At VH, we love the “before and after” because our programming helps our residents go from hopelessness to vibrancy and independence.

LEARN MORE