SPECIAL PROJECTS DONOR ACH AUTHORIZATION FORM

SPECIAL PROJECTS DONOR ACH AUTHORIZATION FORM

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After filling out your personal and bank information on this form, you will be required to submit an E-signature. The E-signature will generate an email confirming your enrollment. You must click on the link in the email for the ACH to be effective. Please allow 2-3 business days for our accounting department to process your request.

Today's Date

Is this form being submitted on behalf of an organization?

YESNO

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Organization Name

First Name

MI

Last Name

Your title with this organization

Business Phone Number

Your Business Email Address

Phone Number

Personal Email Address

Your Home Address Line 1

Address Line 2

City

State

Postal Code

Your Business Address Line 1

Address Line 2

City

State

Postal Code

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FINANCIAL INFORMATION

Name of Financial Institution

Account Type

Checking AccountSavings Account

Account Number

Routing Number (Note: Confirm you have entered the "ABA" routing number. A bank may use more than one type.

TRANSACTION DETAILS

Amount of One-Time Donation (Enter U.S. Dollar Amount)

I believe in the work of BLACKBOX and would like to donate to:

Indigenous Training CenterPersecuted Christian FundJackets for North Korean ChildrenHimalayan Bible TrainingRestore Hope to the Young Women of AfghanistanEvangelistic Art & Music Ministry Among TibetansSyria Emergency ResponseEquipping Leaders in AfghanistanEncourage the Underground Church in the Middle EastCarry Hope to the Nation of YemenGrow the Church in BhutanDeploy South Sudanese to the Unreached

Contact Information