Fillable Printable Auto Dues Payment Agreement

Auto Dues Payment Agreement

Battle Creek Area Chamber of Commerce

34 West Jackson Street # 3A

Battle Creek, MI 49017

269 962-4076

Auto Dues Payment Agreement

I would like to auto pay my dues:

Annually _____ Annual Dues Total $___________________

Payment Method:

Electronic Fund Transfer:

Bank routing number: ____________________________________________________

Bank accounting number: _________________________________________________

Name on the account: ___________________________________________________

Name of Institution: _____________________________________________________

Authorized signature: ____________________________________________________

Credit Card:

Cardholder Name _____________________________________________________

Card Billing Address _____________________________________________________

(City/State/Zip) _____________________________________________________

Card Type _____________________________________________________

(mc, visa, disc, amex)

Credit Card Number _____________________________________________________

Expiration Date ____________________ CVV Number ____________________

Authorized Signature _____________________________________________________

For more information or questions please contact Jennifer Blank at (269)962-4076.