Values Plus Foundation ACH Debit Form

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First Name *

Last Name *

Amount *

Company you work for

Lot of companies partner with us to match their employees donation. We will let you know the eligibility

Donation Towards *

Values Plus Program

Elevate Consciousness through Healthy Food

Other:

Required

Where do I get Routing Number, Account Number details ?

Routing Number *

Bank Account Number *

Transfer Date

Default is immediately on submission.

YYYY

Street Address *

Address 1

Apt/Unit Number

Address 2

City *

Name of City

State *

Zip *

Phone *

Email *

Terms & Conditions

I hear-by authorize Values Plus Foundation, located at 21740 Olive Ave, Cupertino, to initiate a debit entry to my checking or savings account at the financial institution name 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 info@valuesplusfoundation.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.