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Contact Information
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* Last Name 
  Company Name 
* Address 
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* Home Phone 
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Disclosure
     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.  


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


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



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We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited to your account.


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