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S authorization is to remain in e ect until the authorizing person named below has given 30 days written noti cation of termination of this contract. DONOR INFORMATION (please print): Name: Street Address: City: State: Telehone: ( ) ZIP: - Gift Designation Amount: Check One: One-time Deduction Monthly Deduction Gift Designation Area: (college, o ce, unit on campus that you wish to donate to) / Name(s) on Bank Account: Signature(s): / BANK INFORMATION Bank Name: ABA Routing #:.

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