Automatic Bank Draft

Your support in the form of financial assistance is vital to our mission. You can choose to automatically donate to a Wish with Wings each month, saving you both time and postage.

Complete the form below, print and return to:

a Wish with Wings, Inc.

917 West Sanford Street
Arlington, TX 76012


   I authorize my bank to pay a Wish with Wings, Inc., the amount indicated on the day marked below.  This authorization will be the same as if I had personally signed a check and will remain in effect until I notify a Wish with Wings, Inc., that I wish to discontinue my gift.

Please debit my account on the    3rd  or    18th day of each month beginning   (mm/dd/yyyy) in the amount of:    

   $100       $50      $25      $10   
  Other Amount: $ 
 
(specify)

Name: 

Address: 

City:   State:   Zip:

Daytime Phone:

Authorized Signature:

________________________________________________

(Please include your blank voided check.  No deposit slips, please.)

  Remember ... many employers will match your gift.  Please obtain a matching gift form from your employer and send it to:  Matching Gifts, a Wish with Wings, Inc., 917 West Sanford Street, Arlington, TX 76012.