JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
HTSNM ACH Signup
ACH Authorization :
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)
You can revoke this authorization at any time by contacting HTSNM treasurer. Look for BOT members link in
https://htsnm.org/contact-us
HINDU TEMPLE SOCIETY OF NEW MEXICO (HTSNM)
(A NON PROFIT ORGANIZATION - TAX ID 85-0458579)
PO Box 51616, Albuquerque, NM 87181
www.HTSNM.org
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
I (we) hereby authorize HTSNM to initiate debit entries to my (our) Checking Account/Savings Account indicated below at the depository financial institution named below, hereafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.
*
Agree
First Name
*
Your answer
Last Name
*
Your answer
Name on Bank Account
*
Your answer
Bank Account Type
*
Checking
Savings
Other
Bank Name
*
Your answer
Branch
*
Your answer
Phone Number*
Your personal phone number (usually your home phone number) associated with the bank account
*
Your answer
Bank Routing Number *
This is a 9-digit number located on the bottom of your check. It is also know as the ABA number.
*
Your answer
Bank Account Number *
This identifies your individual bank account to the check and is usally an 8-12 digit number
*
Your answer
This authorization is to remain in full force and effect for the duration selected below by me (us). I reserve
the right to change this authorization by informing HTSNM, in writing, in the future.
*
I / We wish to donate $100/mo for 2 years starting from April 8 2023
I /We wish to donate $50/mo for 3 years starting from April 8 2023
I / We wish to donate $________/mo for ____ years starting from 1st of ______ month
I / We wish to donate $_______ one time.
Required
Authorization
*
I authorize HTSNM to initiate either an electronic debit or to create and process a demand draft against my bank account on a monthly basis or as per our payment agreement. I acknowledge that the origination of ACH transactions to my account must comply with the provisioning of United States law.
Required
Fees for unavailable payments
*
If the transaction does not go through, I am still responsible for the original payment as well as any service charges that may have been imposed by the financial institutions.
Required
Duration
*
This payment authorization is to remain in full force and effect until I notify HTSNM of its cancellation by HTSNM and the receiving financial institution a reasonable opportunity to act on it.
Required
Electronic Signature*
Enter your full name here. This acts as your electronic signature.
*
Your answer
Email address*
A confirmation will be sent to your email address when the automatic withdrawals have been set up.
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
