AUTHORIZATION AGREEMENT FOR AUTOMATIC WITHDRAWAL OF FUNDS Our Father’s Children, Inc. ES7568 Donor # (leave blank if not applicable) Last Name First Name Address City State ZipAuthorization Agreement for Automatic Withdrawal of Funds • February 19th, 2009
Contract Type FiledFebruary 19th, 2009Please debit my donation from my (check one):❑ Checking Account (attach a voided check)❑ Savings Account (contact your financial institution for Routing #) Routing Number: Valid Routing # must start with 0, 1, 2, or 3 Account Number: