BANK DRAFT FORM
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Last Name │First Name │Middle Initial
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Street
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City │State │Zip
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Bank Draft Authorization:
I authorize Presbyterian College to initiate debit entries to my account indicated below and the financial institution named
below, hereinafter called Financial Institution, to debit the same to such account for (Application). I acknowledge that the
origination of ACH transaction to my account must comply with the provision of U.S. law.
(For bank draft, please attach copy of
voided check to this form)
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Financial Institution Name Branch
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Address │City │State │Zip
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Routing # Account # │Type of Acct: ( ) Checking ( ) Savings
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Starting Date Monthly Debit Amount
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This authority is to remain in full force and effect until Presbyterian College has received written notification from me of its termination in
such time and manner as to afford Presbyterian College and Financial Institution a reasonable opportunity to act on it.
Notes: *All written debit authorizations must provide that Presbyterian College may revoke the authorization only by notifying the
Originator in the manner specified in the authorization.
* The underlined language in the authorization above represents the disclosure requirement associated with the clarification of OFAC
economic sanction policies upon ACH Network Participants.
I would like to designate my gift as: PC Fund $__________ Scotsman Club $__________
PC Scholarship Fund $__________ Other (please specify) $_______________________________________
Signature:_____________________________________ Date:_______________
Return completed form to:
Presbyterian College
PO Box 975, Clinton, SC 29325-0975
Or e-mail to: rafortman@presby.edu
Call: 864-833-8320
if you have questions.
THANK YOU FOR SUPPORTING PRESBYTERIAN COLLEGE
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