Big Cat Rescue 12802 Easy Street Tampa, FL 33625 (813) 920-4130 fax 885-4457 www.BigCatRescue.org  Info@BigCatRescue.org

 

PREAUTHORIZED DEBITS AUTHORIZATION FORM

CREDIT CARD

 

I (we) authorize Big Cat Rescue Corp., hereinafter called Big Cat Rescue, to initiate debit entries and if necessary, credit entries for adjustments to any debit entries made in error to the credit card account at the Financial Institution as listed below:

 

 

_____________________________ Pin# ______

Name on Credit Card Credit Card Number 3 digit on back

Credit Card Billing Address (Street Address, City, State, Zip)

 

__ ____________________________________

Credit Card Billing Phone Number Other Contact Phone Number for me

 

 

I would like to have $ _________ /month tax deductible donation debited from the account above to support the cats at Big Cat Rescue. This authority is to remain in full force and effect until Big Cat Rescue has received written notification of its termination in such time and in such manner as to afford Big Cat Rescue and Depository Institution a reasonable opportunity to act upon it.

 

__________ Print Name Signature Date

 

 

 

Big Cat Rescue