4 HIM - Make a Donation

PHONE: 405.752.9861
FAX: 405.753.9870

MAILING ADDRESS:
2410 W Memorial Rd
Suite C, #133
Oklahoma City, OK 73134

E-MAIL:
info@4-him.net

I wish for a donation to His Healing Helping Hands International Ministries (4 H.I.M.) to be automatically deducted from my checking/savings account or debited to a debit/credit card. Accordingly, I hereby authorize 4 H.I.M. to initiate debit entries (and any correcting entries, if necessary) to my checking/savings account indicated below.

If I choose for the Payment Duration to be "Monthly", then I understand this authorization will remain in effect until 4 H.I.M. has received written notification from me of its termination, and that such notification must be received by 4 H.I.M. at least ten (10) days prior to the next scheduled payment.

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*Payment Duration :

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*Amount : $

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*Phone No. : (555-555-5555)

Other Phone No. : (555-555-5555)

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*Card Type : Visa Master Card

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*Expriration Date :

*CSC : csc help

Payment Will Begin: On the 15th of the month and/or Every Month

*Bank Name :

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*Phone No. : (555-555-5555)

*Account Type : Checking Saving

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Payment to begin : 8th 24th

By Checking the box below, this certifies that I completed this application and that all entries in it are true and complete to the best of my knowledge. This authority is to remain in full force and effect until COMPANY and FINANCIAL INSTITUTION has received written notification from me for either of use of its termination in such time and in such manner as to afford COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it. Electronic Signatures You acknowledge that by clicking on the "I have read and agree to the above terms" or similar button at the 4-HIM on-line ACH form, you are indicating your intent to sign the relevant document or record and that this shall constitute your signature.

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