ORWB Authorization Form

ORWB Authorization Form

Thank you for setting up a recurring donation to ORWB. Please complete the information below to get started.

Name*

Address*

Name of Your Bank*

9-Digit Routing #*

Account #*

Type of Account*

Select

Amount of Monthly Donation*

Date to Begin Recurring Withdrawal*

Authorize*

By selecting yes below, you hereby authorize ORWB to withdraw monthly donations from the account listed above. This authorization will remain in effect until you modify or cancel it in writing, by emailing rebecca.barnard@orwb.org.

Yes

No

Send me a copy of my responses

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