Humility of Mary Housing, Inc.

ELECTRONIC FUNDS TRANSFER

I, _________________________________________, wish to make a contribution of $____________ each month to Humility of Mary Housing, Inc. through electronic funds transfer.

I would like these funds to be taken from my account on the ____10th or ____26th of each month.

Enclosed is a cancelled check with the necessary information.

When the transfer process has been initiated, Humility of Mary Housing, Inc. will send an acknowledgement of your donation. As a monthly donor you will receive the two newsletters published each year plus the annual report. In January you will receive a letter from us verifying your gifts for tax purposes.

Date_________________ Sign as you sign on your checks_______________________________________

Print Name_________________________________________________________

Any changes in the amount, day of the month, account number or bank should be communicated promptly to Sister Mary Ann Vogel at the HMHI office at (563)326-1330.

Please print this form and mail to HMHI - 1228 E. 12th Street - Davenport, IA. 52803

*****Please attach voided check or deposit slip for the account listed above*****