Payment / Recurring Payment Authorization Form

Donate by ACH

Schedule your payment to be automatically deducted from your bank account. Just complete this form to get started! saving you time and postage!

Here’s How Payment / Recurring Payments Work:

You authorize regularly scheduled charges to your checking/savings account. You will be charged the amount indicated below each billing period. the charge will appear on your bank statement as an “ACH Debit.” You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

Please complete the information below:

I authorize Tomchei Tzedaka corp ACH my bank account.

Name

Amount:

Recurring:

Billing Address

Phone

City, State, Zip

Donation for

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Checking / Savings

Name on Acct

Bank Name

Account Number

Bank Routing #

Bank City/State

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Tomchei Tzedaka corp in writing of any changes in my account information or termination or revocation of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that Tomchei Tzedaka corp may at its discretion attempt to process the charge again, and agree to an additional 10$ charge or amount allowable by law for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.

I certify that I am an authorized user of this bank account and will not dispute these scheduled transactions with my bank; so long as the transactions correspond to the terms indicated in this authorization form.

Bais Hatzedaka corp DBA World of Tzedaka has 501 (c) 3 accreditation, Tax ID 92-2163377

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