Bainbridge Decatur County Humane Society
ACH Draft Authorization

We are so grateful for our supporters and hope to make it as easy as possible for you to "Help the Helpless".

If you would like to have your monthly donation auto drafted, please fill out and submit this form and upload a picture of a voided check, or email a copy of your voided check to or call our office to arrange a time to bring one by.

If you would be more comfortable, you may print out the ACH Draft Authorization form and bring it, along with your voided check, to our office. Thank you again for supporting the Bainbridge Decatur County Humane Society!

Please check the appropriate line(s):
New Bank Draft Customer
Current Bank Draft Customer
Changing Banks
Changing Bank Accounts
Is this a: Checking Account     or   Saving Account
Name Of Customer
Name(s) On Bank Account
Mailing Address
eMail Address
Contact Telephone
Name Of Financial Institution
Bank Phone Number
ABA Routing Number
(Look between symbols |:|: on your check)
Bank Account Number
(Generally, located to the right of the ABA Routing Number.)
Amount To Be Donated Each Month  
Date to take effect  
Please Type Name for Required Signature

After submitting form, please upload an image of a voided check or deposit slip.
(or email a copy to