Visionary Brick Campaign
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUND TRANSFER
Organization Name Organization Identification Number
Sacramento Asian Sports Foundation 94-3227001
We (I) hereby authorize the Sacramento Asian Sports Foundation, hereinafter called ORGANIZATION,
to initiate debit entries to our (my) checking account indicated below from the depository institution
named below, hereinafter called FINANCIAL INSTITUTION, to debit the specified amount to such
account on or within 3 days after the 15th of each month. This agreement will run for the chosen
specified length after the initial donation (effective date) is recorded.
For accounting purposes please select one of the three payment options:
3 months @ $334.00 6 months @ $167.00 12 months @ $84.00
Effective Date: ____________________________
(to be filled out by SASF)
Financial Institution of Donor (Please Print)
Institution Name: __________________________________________________________________________
City: _______________________________________ State: ____________ Zip: ________________
Please attach a voided check or deposit slip. A SASF representative will fill out the American
Banking Association (ABA) Transit Number and Bank Account Number.
ABA Transit Number Bank Account Number
Donor Name(s) (Please Print) Signature Date
* This authority is to remain in full force and effect until Organization receives a letter from the donor for its termination in such
time and in such manner as to afford Organization and Financial Institution a reasonable opportunity to act.
Please return White copy to SASF and retain Yellow copy for your records.