| To enroll for automatic funds transfer print, fill out, and mail this form.
Direct Your Gift - ___The University Fund, supporting the full scope of the University's mission, including student scholarships. ___Other: ________________________________ How much? I hereby authorize Seattle Pacific University to initiate monthly debit entries of $___________________ ($10 minimum amount) from my: A) ___Checking Account Number: _______________________ or B) ___Savings Account Number: ________________________ I further authorize the financial institution named below to debit my account. I would like the transaction to take place on the: ___ 10th of each month or ___ 25th of each month. I understand that this authorization remains in effect until I provide Seattle Pacific University written notice to terminate the transactions. Financial Institution: _________________________________ Branch: __________________________________________ Address: _________________________________________ City: _____________________________________________ State: ____________________________________________ Zip: ______________________________________________ Name of Account Holder: _____________________________ Name of Joint Account Holder: ________________________ Note: Please send a voided checkwith this form. We must have the voided check to complete your gift process. or C) Credit Card Charge to my __________________________ (Visa or Mastercard only) Name on Credit Card: _______________________________ Credit Card Number: ________________________________ Expiration Date: _____________(Month) ___________(Year) Signature: _________________________________________ Date: _____________________________________________ Please mail to: Seattle Pacific University |