ELECTRONIC FUNDS TRANSFER INFORMATION
To set up your electronic funds transfer, please complete the information below and return to:
Vanderbilt University
Gift and Donor Services
PMB 407727
2301 Vanderbilt Place
Nashville, TN 37240-7727
Name: ___________________________________________________________________________________________
Address: __________________________________________________________________________________________
City:___________________________________________________ State: _____________ ZIP code:______________
Phone: ____________________________________________ Email: _________________________________________
I (we) authorize Vanderbilt and the financial institution named below to electronically charge my (our):
q checking q savings account specified below:
Account number: __________________________________________________________________________________
Routing number: ___________________________________________________________________________________
Bank name: _______________________________________________________________________________________
City:___________________________________________________ State: _____________ ZIP code: ______________
Day of month: q 3rd banking day q 12th banking day
I authorize $__________ per month/quarter for a total of $__________ per year.
Frequency: q Monthly q Quarterly (January, April, July and October)
Date plan to commence __________ Month ________ Year
Designation _______________________________________________________________________________________
It is understood this agreement may be terminated by me (either of us) at any time by written notification to Vanderbilt
University. Any such notification to the university shall be effective only with respect to entries initiated by the university
after receipt of such notification and a reasonable opportunity to act on it.
__________________________________________ __________________________________________
AUTHORIZING PARTY (PLEASE PRINT) AUTHORIZING PARTY (PLEASE PRINT)
__________________________________________ __________________________________________
Signature Date Signature Date
Thank you for your support of Vanderbilt University.
