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Financial Institution Information
Automatic Account Withdrawal Authorization
By initialing electronically at the end of this paragraph I (we) hereby authorize Three Rivers Humane Society hereinafter called TRHS to initiate debit entries to my (our) Checking Account or Credit Card account as indicated below at the depository financial institution named below, hereinafter called Depository, and to debit to the same such account. Monthly Withdraws will be initiated on the 5th (or next closest business day) of the month.
Credit Card Information
Checking/Savings Account Information
By signing your name as an electronic signature below you agree that this authorization is to remain in force and effect until TRHS has received written notification from me (or either of us) of its termination in such time and in such manner as to afford TRHS and Depository a reasonable opportunity to act on it.