Our commitment to you
If you choose to make a financial investment in our organization, our commitment to you is that all
funds are used wisely and with complete accountability to our community. Every gift is invested
in the lives of the women who come for help and in the lives of their unborn children.
I (we) hereby authorize the Open Door Pregnancy Center to initiate entries to my Checking or
Savings accounts at the financial institution listed.
(Name of financial Institution) _____________________________________________________________________________
and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority
will remain in effect until the Open Door Pregnancy Center is notified by me (us) in writing to
cancel it in such time as to afford the Open Door Pregnancy Center and
(Name of financial institution)______________________________________________________
a reasonable opportunity to act on it.
Name of Financial Institution ______________________________________________________
Address of Financial Institution - Branch, City, State, Zip _____________________________________________________________________________
Signature___________________________ Date _____________________________________
Name (PLEASE PRINT)
Address (PLEASE PRINT)________________________________________________________
Draft to be drawn on this Date_____________ of each month in the amount of_______________.
Checking/Savings Account Number_________________________________________________
Financial Institution Routing Number________________________________________________
PLEASE INCLUDE A VOIDED BLANK CHECK.
For your gift to be tax deductible, please make your contribution payable to the Open Door
Pregnancy Center. Or, your commitment with your check in any amount is greatly appreciated!
*The Open Door Pregnancy Center is an organization exempt under Section 501(c)(3)
of the Internal Revenue Code.