$13/mo Challenge

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$13/mo Challenge

Donating $13/month for one full year can pay for a membership, Rock Band fees, classes throughout the year, or private music lessons for a student in need! A little bit goes a long way. Fill out the form to start changing lives!

$13 x 12 months = 1 Membership
$39 x 12 months = 3 Memberships
$65 x 12 months = 5 Memberships (You get the idea…)

AUTHORIZATION FOR DIRECT DEBIT
(Note: these donations will continue after 12 months unless otherwise cancelled by you and your financial institution.)

I would like to support the arts and make a $13 donation every month.

I would like to support the arts and make a $39 donation every month.

I would like to support the arts and make a $65 donation every month.

Other:

Clear selection

Authorization to withdraw

I hereby authorize Eastern Iowa Arts Academy to initiate debit entries to my account indicated below on or about the _____ of each month (filled out below), and the depository financial institution named below to debit the same to such account. I acknowledge that the origination of AHC transactions(s) to my (our) account must comply with provisions of U.S. law.

When would you like your donation to auto-withdraw?
Please enter a date.
Example: "Every month on the 15th."

(If your preferred date lands on a weekend or a holiday, your withdraw may happen on the next business day)

Banking Information for Withdraw

What's the name of your Financial Institution?

Does your Financial Institution have multiple branches? If so, which branch?

What's your Financial Institution/Branch's address?
STREET ADDRESS
CITY
STATE

ZIPCODE

What's your routing number?

What's your account number?

What type of account are you using?

Checking

Savings

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What's your name/the name listed on your account?

What's your phone number?

What's your address?
STREET ADDRESS
CITY
STATE

ZIPCODE

What's your email address?

By selecting "Yes" you are consenting to an auto-withdraw from your account in the amount you previously selected above on the date you chose (if your selected date lands on a weekend or a holiday, it may be withdrawn the next available business day). This auto-withdraw will continue until you cancel.

Yes

Clear selection

Submit

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