Omega Giving Club

Donation Information

Chi Phi Brother,

Thank you for your participation in the Omega Giving Club.

Please fill out the attached donation form, attach a voided check (or a copy of one) and send to:

Omega Trust Association

ATTN: Treasurer

245 N. Highland Ave.

Suite 230-159

Atlanta, GA 30307

If you have any questions, please contact your giving captain:

Pre 80's - Dave Skelton ('80) - - 770.231.4573

The 80's - Tim Semones ('81) - - 208.720.5927

The 90's - Brian "Bert" Betkowski ('00) - - 678.480.2091

The 00's - Jay Crockett ('01) - - 404.435.7629

Thank you again for your support of Chi Phi!

Fraternally,

Omega Trust Association


Omega Giving Club

Donation Form

Please complete and mail to:

Omega Trust Association

ATTN: Treasurer

245 N. Highland Ave.

Suite 230-159

Atlanta, GA 30307

Authorization Agreement for Electronic Withdrawals (ACH Debits)

Please fill in all the information below.

Personal Information
Full Name
Mailing Address
Phone Number
Email Address
Graduation Year
Pledge Year
Preferred Contact Method (circle one) / Phone / Email / Mail / Other ______
Authorization Agreement
I (we) hereby authorize THE OMEGA TRUST ASSOCIATION, hereafter called OTA, to make ACH withdrawals from my account at the financial institution named below. I (we) also authorize OTA to initiate direct deposits into this account in the event that a debit entry is made in error. I (we) acknowledge that the origination of ACH transactions to or from my account must comply with the provisions of U.S. law.
This agreement will remain in effect until OTA has received a written notice of cancellation from me (us) in such time and in such manner as to afford OTA a reasonable opportunity to act on it.
Donation Amount and Payment Method
Monthly Donation / $
Name of Financial Institution
ABA Routing Number
Account Number
Account Type (Checking or Savings)
*** Please attach a voided check (or a copy of one) when returning this form to OTA ***
Signature
Account holder(s), please sign here. Joint accounts require the signature of all persons having authority over the account.
Authorized Signature (Primary) / Date
Authorized Signature (Joint) / Date