EFT FORM | Global Associates

Electronic Giving Request

Yes, I/we authorize Global Service Associates to initiate debit entries directly from my/our account maintained at the bank named below.

Account Type:

Checking

Savings

Start Date of Donation:

Bank Name

Bank Address (City, State, Zip)

Routing Number

Account Number

Each donation is to be designated to Global Service Associates account as indicated:

Amount (in dollars)

Preference for (Name of Member or Project)

This authority is to remain in full force and effect until Global Service Associates has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Global Service Associates and my bank a reasonable opportunity to act on it.

Today's Date

First name

Last name

Address

Phone

Email

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

If you have any questions, please contact us at 303-214-5331 ext. 2 or gsadonations@globalassociates.org.

Donations Mailing Address: Global Service Associates P.O. Box 6033 Broomfield, CO 80021