Join / Contribute

Become an Automatic Activist

in three easy steps!

1. Print the form below.
2. Complete all information.
3. Send it back to MHRN with a deposit slip or voided check.

AUTOMATIC WITHDRAWAL authorization form

I authorize the Montana Human Rights Network to withdraw $_____/month from my account between the 7th and 12th of each month.  The withdrawal will begin the month after the date below.  The contribution will continue until I request in writing that the amount change, the account number change or the automatic withdrawal terminate.  I have enclosed a check for the account from which I wish the contribution to be drawn.

Signature_________________

Print Name___________________

Date________