Brew Fest 2019 Donation

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First Name Last Name

Street Address

Postal Code City State/Province

Email Home Phone (Optional)

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Payment

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Account Type Routing Number What's This? Account Number What's This? Confirm Account Number I authorize the use of my bank account as a payment method and authorize this organization to debit my bank account via the Automated Clearing House system to fulfill my donation commitment. This authority will remain in effect until revoked in writing by the account holder.

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Citizen Action of Wisconsin