VIRGINIA TECH FOUNDATION, INC. AUTHORIZATION FOR PRE-ARRANGED PAYMENTS (ACH DEBITS)
|I (We) hereby authorize the Virginia Tech Foundation, Inc. to initiate
debit entries and/or correction entries to our
account (select one) indicated below at the depository
named below, herein after called DEPOSITORY, to debit the same to each account.
This authorization is to remain in full force until the Virginia Tech
Foundation, Inc., has received written notification from me (or either of us) of its
termination in such time and in such manner as to afford the Virginia Tech Foundation,
Inc. and the DEPOSITORY reasonable opportunity to act upon it.
Amount: $_________ per month Begin Deduction on ______________(month) 15 28 _________(year)
Desired Club Level:
Hokie Representative: Greg Shumaker (22G)
Please attach a voided check (if using a checking account) or a deposit slip (if using a savings account). For security purposes, please do not fax or email this form. Return this form and all attachments to Gift Accounting, VTAF, P.O. Box 10307, Blacksburg, VA 24062. Please contact one of our gift accountants at email@example.com or by phone (540) 231-6618 with any questions.