SPECIAL PROJECTS DONOR ACH AUTHORIZATION FORM

SPECIAL PROJECTS DONOR ACH AUTHORIZATION FORM

Page 1

After filling out your personal and bank information on this form, you will be required to submit an E-signature. The E-signature will generate an email confirming your enrollment. You must click on the link in the email for the ACH to be effective. Please allow 2-3 business days for our accounting department to process your request.

Today's Date

Is this form being submitted on behalf of an organization?

YESNO

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Organization Name

First Name

MI

Last Name

Your title with this organization

Business Phone Number

Your Business Email Address

Phone Number

Personal Email Address

Your Home Address Line 1

Address Line 2

City

State

Postal Code

Your Business Address Line 1

Address Line 2

City

State

Postal Code

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FINANCIAL INFORMATION

Name of Financial Institution

Account Type

Checking AccountSavings Account

Account Number

Routing Number (Note: Confirm you have entered the "ABA" routing number. A bank may use more than one type.

TRANSACTION DETAILS

Amount of One-Time Donation (Enter U.S. Dollar Amount)

I believe in the work of BLACKBOX and would like to donate to:

Indigenous Training CenterPersecuted Christian FundVocational Skills Education for Displaced ChristiansTrauma Care & Skills Training for Women in the Middle EastRestore Hope to the Women of AfghanistanProtection From the ElementsJackets for North Korean ChildrenHimalayan Bible Training

Contact Information