Electronic Funds

Transfer

Your gift or annual pledge can be given monthly, quarterly, or once a year, with an automatic transfer from your account to the Women’s Foundation.

Benefits of giving with this option:

You control the amount and timing of your gift to the Women’s Foundation of Genesee Valley. Choose from monthly, quarterly, or annual deductions, and the date you find most convenient.

  • You can spread your pledge evenly over the entire year, and the Women’s Foundation of Genesee Valley can count on an even flow of giving.
  • You can increase your giving with minimum impact to your budget.
  • In advance of your payments, you receive statements, so you can maintain your check register accurately. For those giving once a year, a confirmation statement is issued a month ahead of the deduction date.

To become a Sustaining Donor and use Electronic Funds Transfer, complete the attached Authorization Form and return with a photocopy of a personal check. Make sure the special characters at the bottom of the check copy are clear; you can write "VOID" across the copy but you need not send an actual check or deposit ticket.

Total annual amount authorized; please check one:

$5,000$300

$2,500$120

$1,000Other $

$600

NOTE: there is a $10 monthly minimum for this giving option.

I want my gift to be deducted from my (our) bank account on * (date of each month); or, if quarterly, the * (date of September, December, March, and June); or on each year.

MonthDate

A debit line item or description will automatically appear on your bank statements.

* Or the closest business day following the chosen date

Changes; cancellations

If you change banks or if you want to change the amount, contact us for a new authorization form. To end the automatic withdrawals, please let us know 30 days in advance of a scheduled debit.

Questions?

Women’s Foundation of Genesee Valley

277 Alexander St., Suite 305

Rochester, NY 14607

Voice: 585.242.0940

Fax: 585.242.0632

Email:

Website:

Name

Home Address (include Apt, Unit, etc. if applicable)

City/State/ZIP Telephone

Email address:______

Name of Bank, Credit Union, or Money Market Fund

City/State

Checking (or other: Savings, Money Market Fund, Credit Union) Account Number

I authorize the Women’s Foundation of Genesee Valley to deduct from my checking/other account as follows:

$ Each month ($10 minimum/ month), on the (date) of the month, or

$ Each quarter ($25 minimum/qtr), onthe (date) of Sept/Dec/March/June, or

$ Per year ($100 min/year) on

Month

Each year.

Date

Matching Gift Firm/Foundation, if applicable:

Check one:Self Spouse

Important: Please enclose a photocopy of your check for account verification. Return

this form to the Women’s Foundation in the enclosed envelope.

Signature Date