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     I authorize the Washington Agriculture and Forestry Education Foundation (AgForestry) to initiate monthly or annual withdrawals from my account at the financial institution named in this application for payment of my yearly membership to AgForestry. This authorization will remain valid until I, AgForestry or my financial institution revokes it. Annual withdrawals will be made on the 5th of the month indicated. If I wish to discontinue my participation in the Direct Payment Plan, I may do so by notifying AgForestry at any time prior to 4:00 pm, five business days before the payment is scheduled to be deducted from my account. I understand that AgForestry and my financial institution reserve the right to terminate the Direct Payment Plan and my participation in it.  

  I have read the disclosure and I authorize direct payment to AgForestry for my annual membership. 

Account Information
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  Based off your Withdrawal Duration Select Either:  
  Monthly Direct Payment Date    or Annual Payment Month 
  Name of Financial Institution 
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  Bank Account Number 
  Amount of Monthly Payment 

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