If you are looking for a way to make an impact and assist animals in need, the Humane Society of the Lakes has various monetary sponsorship programs available through automatic bank withdrawals. Those who wish to participate can cancel at any time. Please select which sponsorship you are interested in: Donate 50 cents a day (ACH will withdraw on the 15th each month for $15) Donate $1 a day (ACH will withdraw on the 15th each month for $30) Donate $2 a day (ACH will withdraw on the 15th each month for $60) Donate $5 a day (ACH will withdraw on the 15th each month for $150) ____/Month: you can choose your monthly contributions I (we) hereby authorize the Humane Society of the Lakes hereinafter called COMPANY, to initiate debit entries to my (our) Checking Account/ Savings Account indicated below at the depository the financial institution named below, hereafter called DEPOSITORY. This will also be considered authorization to credit said account in the event a refund is deemed appropriate. If necessary, I authorize COMPANY to make correcting credit/debit entries and adjustments for entries made in error. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U. S. law. Depository (bank) Name ____________________________________________________ Bank Address ____________________________________________________________ City __________________________________ ST _________ ZIP ___________________ Routing Number __________________________ Account Number ___________________ This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. Name (please print): _______________________________________________________ Date: _______________ Signature: ________________________________________ 19665 US Hwy 59, Detroit Lakes, MN 56501 | (218) 847-0511 | https://humanesocietyofthelakes.org 7
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