Animal Friends of Barbour County
We are pleased to offer you an easy way to send your donation to us through the Direct Payment Plan.
Now you can have your donation automatically deducted from your checking or savings account. And, you won’t
have to change your present banking relationship to
take advantage of this service.
The Direct Payment Plan will help you & us in several ways:
It saves time - fewer checks to write and mail.
It helps get your donation to us always on time -
even if you are on vacation or out of town.
It saves you money on postage.
It’s easy to sign up for, and easy to cancel.
Here’s how The Direct Payment Plan works:
You authorize regularly scheduled payments to be made from your checking or savings account. Your payments will be made automatically on the specified day of the month or day of a specific month. Proof of payment will appear on the statement you receive from your financial institution.
Please complete the information below and mail it to AFOBC PO Box 452 Philippi WV 26416
I authorize Animal Friends of Barbour County, West Virginia to initiate electronic debit entries to my
_____ checking account OR ______ savings account
for payment of my donation of $ _____________ to be deducted on
the ______ of every month OR Yearly on the ______ of specific month: ______
I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.
This authority will remain in effect until I have cancelled it in writing to AFOBC PO Box 452 Philippi WV 26416
PLEASE PRINT:
Your Name __________________________________________________ Phone # ________________________
Financial Institution name___________________________________________________________________________
Financial Institution City_____________________________ Financial Institution State____________________
Account # at Financial Institution______________________ Financial Institution Routing #____________________
Today’s Date______________________ Signature_____________________________________________________
The authority you give us to debit your account will remain in effect until you notify us, in writing, to terminate this authorization.
The address you would write to is:
AFOBC P.O. Box 452, Philippi WV 26416
To take advantage of this easy way to help us:
1) Mark the box by type of account to indicate whether your payment will be deducted from your checking or savings account.
2) Enter donation amount to be debited.
3) Enter when donation is to be debited.
4) Fill in your name, phone number, and Financial Institution’s name, City and State.
5) Attach a voided check for your account number and Financial Institution’s routing number. If you are unable to attach the voided check, please fill in the routing number (1st set of numbers on check), and account number (middle set of numbers on check).
6) Be sure to date and sign the form at the bottom.
