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To confirm your monthly gift, please make sure to complete and mail us the authorization form available for download on the next page.
authorize St. Jude Children's Research Hospital to initiate electronic withdrawals (debits) to my checking account up to $
on August 04, 2015
that will be processed through the regular banking system. This authorization is to remain in full force and effect until St. Jude Children's Research Hospital has received written notification from me of the termination of my authorization in such time and in such manner as to afford St. Jude Children's Research Hospital and my financial institution a reasonable opportunity to act on it. If my payment is returned, additional attempts may be made to process my payment, and I will be charged a returned item fee up to the maximum allowed by law.