Kemmerer Village - Direct Donation Plan

Donations - Direct Donation Plan

To give via credit card, click here.

Name (account holder)	A value is required.
Address	A value is required.
City, State, Zip	A value is required.
Telephone	A value is required.
I authorize Kemmerer Village to instruct my Bank / Financial Institution (named below) to debit my account in the amount specified on the date indicated on this form. I am aware I can discontinue this service by simply calling or writing Kemmerer Village with at least ten days notice. Kemmerer Village reserves the right to discontinue the service or my participation in it.
Bank / Financial Institution	A value is required.
Routing Number	A value is required.
Account Number	A value is required.
Account Type
Payment Options	One time donation Monthly, on the 1st Monthly, on the 15th Quarterly, 1st of Jan., Apr., Jul., Oct. Quarterly, 15th of Jan., Apr., Jul., Oct. Please make a selection.
Gift Amount Per Withdrawl	A value is required.
First Withdrawl Date	A value is required.
Your Electronic Signature	A value is required.
Today's Date	A value is required.