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Get EFT Authorization - Uwstout

Name Address City State Zip Home Phone# Work Phone# E-mail I authorize the Stout University Foundation to deduct from my q checking q savings account until further notice as follows (enter one figure) $ monthly ($10 minimum), or $ quarterly ($25 minimum) q My gift is unrestricted. q I designate that my gift be used by the University of Wisconsin-Stout restricted to: U N I V E R S I T Y O F College/Department/Unit q My employer or my spouse s employer.

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