Authorization for Donations Form

		CREDIT CARD CHARGE AUTHORIZATION I hereby authorize the Harris County Green Party to initiate monthly charges to my credit card account at the financial institution listed below.  This authority will remain in effect until five days after I provide written notice to cancel it.         __________________________________       _________________________________     ________________________ Your Name  (please print)                                    Bank Name                                                    Card type (Mastercard/Visa) __________________________________       ________________________________      ________________________ Your Billing Address                                              Card No.                                                       Expiration date ___________________     ____   _______       ________________________________       ________________________ City                                    State    Zip               Your Signature                                                         Today’s Date   Thank you for making your contribution electronically.  We try hard to be good stewards of your donations and have discovered this means of giving is by far the most cost effective means for us to receive and saves a great deal of staff time.  Most important is that your giving electronically allows us to plan.  You are enabling the staff and volunteers to spend our time on the missions and less time managing day-to-day expenses as we can count on receiving your gift on a scheduled date.  We appreciate your willingness to share in this meaningful way.  We trust you will find the convenience equally as satisfying.  We ask you to complete the form as some items are required by the Texas ethics commission. Harris County Green Party, P.O. Box 271080 Houston, Texas 77277-1080     DIRECT BANK DRAFT AUTHORIZATION I hereby authorize the Harris County Green Party to initiate entries to my checking or savings account at the financial institution listed below.  This authority will remain in effect until five days after I provide written notice to cancel it.        __________________________________       _________________________________     _________________________________ Your Name  (please print)                                    Bank or Credit Union Name                           Account Number  (see sample below)    __________________________________       _________________________________     _________________________________ Your Address                                                         Bank or Credit Union Address                        Transit / ABA Number (see sample below) ___________________    ____    _______      ____________________   ____   _______ City                                     State    Zip             City (Bank)                         State      Zip __________________________________         ___________________ Your Signature                                                          Today’s Date                                        (Please attach a copy of or a void check- deposit slips don’t work)