Authorization agreement for Electronic Funds Transfer
This form authorizes India Heritage Foundation / Sri Krishna Balaram Mandir (IHF-USA.org / kbmandir.org) to withdraw an amount specified by you from your checking or savings account, on a one time or periodic basis. Using ACH mode to deduct money from your bank account will save around 3% fees charged by financial institutions like Paypal/Credit Cards/Square. You can override previous authorizations any time, by submitting a new entry form, with your modifications specified below.
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Donation Towards *
Please specify which department you would like to apply your donation.
Required
Amount *
Enter amount of dollars to be deducted either once or every period.
Frequency of donation *
Please select one of option below to indicate one time or recurring donation
Start date
Default is immediately start on submission.
MM
/
DD
/
YYYY
End date
Stop date for recurring donations (Leave it empty for one time donation. For recurring donations, if you are not sure now, you can send email to treasurer@ihf-usa.com anytime)
MM
/
DD
/
YYYY
First Name *
Exactly as in your bank account
Last Name *
Exactly as in your bank account
Bank Routing Number and Account Number details
Bottom line of your personal check has the required details, as shown in this image.
Routing Number *
ABA routing number (the first 9 digits on your bottom line of your check)
Bank Account Number *
The digits following the routing number.
Street Address *
Address 1
Apt/Unit Number
Address 2
City *
Name of City
State *
Zip *
Phone *
Email *
I hearby authorize India Heritage Foundation, 680 E Calaveras Blvd, Milpitas, CA 95035 to initiate a debit entry to my checking or savings account at the financial institution mentioned above. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I understand I can cancel this authorization any time, by sending an email to treasurer@ihf-usa.org *
Please enter your full legal name. The entry below will act as your Digital Signature.
Submit
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This form was created inside of India Heritage Foundation.