Download ACH DEBITS Form

Consumer Authorization for Direct Payment VIA ACH (ACH DEBITS)

To complete your donation, please fill out and mail this form to:
Valle Catholic Schools Foundation ◦ PO Box 255 ◦ Ste. Genevieve, MO 63670.

Direct Payment via the Automated Clearing House (ACH) Network is the secure transfer of funds from a consumer checking or savings account to an individual or organization account for the purpose of making a payment or donation. Making a direct payment via ACH provides a quick, convenient, and convenience fee free way to donate to the Valle Catholic Schools Foundation.

I (we) authorize Valle Catholic Schools Foundation to electronically debit my (our) account (and, if necessary, electronically credit my (our) account to correct erroneous debits) as follows: (select one)

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for $ on the following basis: (check one)

on the | day of each: ||

at the depository financial institution named below (“DEPOSITORY”). I (we) agree that ACH transactions I (we) authorize comply with all applicable law.

Depository Name:

Routing Number Account Number

I (we) understand that this authorization will remain in full force and effect until I (we) notify Valle Catholic Schools Foundation in writing via email to admin@valleschoolsfoundation.org or writing by mail to Valle Catholic Schools Foundation, PO Box 255, Ste. Genevieve, MO 63670 that I (we) wish to revoke this authorization. I (we) understand that Valle Catholic Schools Foundation requires at least 10 business days prior to notice to cancel this authorization.

Name(s):

Signature(s):

Email Address:

Date

An email confirmation from the Valle Catholic Schools Foundation will be provided once this form is received.