| ITPS
Direction
Donation Enrollment Form Yes,
I would like to begin making my monthly
contribution through the Direct Donation
Plan
with a total monthly gift of $
_____________ .
I have enclosed a check
for my first month's gift. Please
transfer my monthly gifts from my
bank account. I understand the my future
monthly gifts will be transferred
directly from my banking account and will
appear on my bank statement. If at any
time I wish to increase, decrease or
suspend my donation, I can email
International Teacher Placement Service
at "francis@ITPSusa.org".
| Name: |
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| Address: |
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| City: |
__________________________________________ |
| State: |
__________________________________________ |
| Zip: |
__________________________________________ |
| Telephone: |
__________________________________________ |
| Email: |
__________________________________________ |
| Signature: |
__________________________________________ |
| Date:
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