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Alumni Fund Scholarship

Midwest Gift Express (Electronic Funds Transfer)

When your bank automatically transfers your monthly gift to Midwest University, you maximize your giving by eliminating mail processing time and cost. We do all the work for you!

To set up your monthly Electronic Funds Transfer, provide the information requested below, printed copy of this form, sign and date the form, and mail it, along with a voided check, to the address listed below. Be sure to keep a copy of the signed form, or request a copy from us. Contact us if you have any questions.

Mail this completed form along with a voided check to :

Midwest University
851 Parr Rd. Wentzville, MO 63385 U.S.A.

I hereby authorize Midwest University to initiate debit entries to my account at the financial institution indicated on the enclosed check or sharedraft, for the monthly amount marked below, and to debit the same to such account on the 2nd day of each month, in accordance with the terms and conditions listed below :

Please designate my gift to :

Alumni Scholarship Fund

Area of Greatest Need

Scholarship Fund :

Area of

Other :

Describe any special instructions regarding your gift :

Monthly gift amount : $100 $50 $25 Other $
(I am including a voided check, showing the amount to be charged back each month.)

Your financial institution account number :

Your financial institution ABA number :

Signature :

Date Signed :

This authorization shall remain in effect until I notify Midwest University in writing that I wish to end this agreement, 14 days prior to the scheduled draft date. My authorization for Midwest University to draft my account at my financial institution shall be the same as if I had personally signed a check to Midwest University. A record of each draft will be included in my checking account statement. Midwest University will also provide me with a receipt of my transfers on a monthly basis.

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