Auto Withdrawal Form

Please fill out the form below to start an automatic monthly withdrawl from your checking or savings account.

Disclamier:

By clicking submit you are authorizing Platte Valley Youth for Christ to intiate electronic debit entries to the account that you specify, for a monthly donation of the amount you disclose. You acknowldege that the origination of ACH transaction to your account must comply with the provisions of U.S. law. This authority will remain in effect until you have cancelled it in writing. Upon recieving your completed donation form our administrative staff will contact you to verify all information.