Name: _____________________________
Address: ___________________________
City/State/Zip: ______________________
Phone: ____________________________
E-mail: ____________________________
Person you would like to support: _______________________
Please take funds from my:
__ Checking ___
Savings
Account Number: ___________________
Routing Number (usually found in the lower left-hand of your
check):
______________________
I authorize the transfer of $__________ from my bank account to
the bank account of All Nations Family. I understand a record of each donation
will be included on my monthly bank statement.
Signature ____________________________ Date ___________
Please send me an e-mail confirming receipt of this form by
clicking on floyd.mcclung@gmail.com
when you have filled it out. Please send a printed and signed copy to the
address below.
All Nations Family, Inc. is a non-profit, 501©3 organization. Your
contributions are tax-deductible. You will receive an annual statement of
contributions for your records. Please mail this form, along with a check
marked VOID, to:
Mark Smith
Walsh Washburn LLC
5330 College Boulevard
66211
Thank you!