Donate - WDRT

I would like to donate *

Contact Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Bank Information

Name on Account *

Bank Name *

Account Number *

Routing Number *

Account Type *

Checking
Savings

Other Information

Would you like to receive a tax receipt? *

Yes
No

For donations over $60: Would you like a WDRT T-Shirt? *

Yes
No thanks, give all my money to WDRT.

What size would you like?

How would you like to receive it?

Pickup
Mail

Anything you'd like to share with us?

Signature

I authorize Driftless Community Radio (DCR) to charge my bank account each month for my WDRT Sustaining Membership using the information on this form. I understand this agreement will remain in effect until I cancel it in writing to DCR. I understand my payment will be executed on or around the 15th of each month and that this may vary with weekends and holidays. In the case of a transaction that is rejected for insufficient funds, I understand DCR may attempt to process the charge again within 30 days, and agree to an additional charge for each attempt to cover costs associated with this. I acknowledge that the origination of ACH Recurring Payment transactions to my account must comply with the provisions of the U.S. Law, and I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the agreed-upon terms indicated in this form.

By checking this box, I agree to the above.

Support Community Radio

Contact Information

Bank Information

Other Information

Signature