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Credit/Debit Authorization Form

Thank you for committing to support Healing House on a recurring basis! Your ongoing support allows Healing House to more confidently plan for the future.

Asterisk(*) indicates required field.

  • I (we) hereby authorize Healing House, Inc. to initiate entries to my checking/savings accounts at the financial institution listed above (The Financial Institution); and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until Healing House, Inc. is notified by me (us) in writing to cancel it in such time as to afford Healing House, Inc. and The Financial Institution a reasonable opportunity to act on it.