Faithful Friends Club

Yes I think every life is worth saving!

Your Information

Please fill out the information below.

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.
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