Auto Dues Payment Agreement
Battle Creek Area Chamber of Commerce
34 West Jackson Street # 3A
Battle Creek, MI 49017
269 962-4076
Auto Dues Payment Agreement
I would like to auto pay my dues:
Annually _____ Annual Dues Total $___________________
Payment Method:
Electronic Fund Transfer:
Bank routing number: ____________________________________________________
Bank accounting number: _________________________________________________
Name on the account: ___________________________________________________
Name of Institution: _____________________________________________________
Authorized signature: ____________________________________________________
Credit Card:
Cardholder Name _____________________________________________________
Card Billing Address _____________________________________________________
(City/State/Zip) _____________________________________________________
Card Type _____________________________________________________
(mc, visa, disc, amex)
Credit Card Number _____________________________________________________
Expiration Date ____________________ CVV Number ____________________
Authorized Signature _____________________________________________________
For more information or questions please contact Jennifer Blank at (269)962-4076.
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