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BOYS AND GIRLS CLUB OF LAREDO INC
500 MOCTEZUMA STREET, Laredo
Texas, 78040.

$

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Donation - Boy and Girls Clubs of Laredo

0000 0000 0000 0000 cardholder name expiration card number 01/23 VALID THRU
985 CVV/CID John Doe

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Acknowledgment

The customer hereby authorizes BOYS AND GIRLS CLUB OF LAREDO INC to debit their bank account for all funds due to BOYS AND GIRLS CLUB OF LAREDO INC, without regard to the source of such funds in the account. With respect to Automated Clearing House (ACH) settlement of transactions (i.e., electronic debits and credits to and from the customer's bank account), the customer hereby agrees to be bound by the terms of the operating rules of the National Automated Clearing House Association and authorizes BOYS AND GIRLS CLUB OF LAREDO INC to initiate ACH debit or credit entries and adjustments to the bank account for all products and/or services provided.

BOYS AND GIRLS CLUB OF LAREDO INC shall not be liable for any delays in receipt, debit, or disbursement of funds, or errors in account entries caused by third parties including, but not limited to, the Association or the bank. The customer shall not close the account without providing BOYS AND GIRLS CLUB OF LAREDO INC with written notice of such closure and substitution of another account at least five (5) days prior. The customer shall be solely liable for all fees and costs associated with the account.

If BOYS AND GIRLS CLUB OF LAREDO INC initiates ACH transactions to the customer's bank accounts, all parties agree to be bound by all terms of the most recently signed ACH agreement. In all cases, the customer shall ultimately be responsible for all funds due.

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