Donor Information

When you make recurring donations to Clarehouse through our monthly giving program, you ensure that our care and education
will be available for people in need.

We are grateful to our monthly donors for their ongoing support.

* Required Fields

Electronic Bank Transfer Form

Statement of Authorization I (we) hereby authorize Clarehouse, Inc. to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my (our) selected account (Checking or Savings) indicated below at the depository named below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account.

I agree to the statement of authorization.

Contact Information

First Name

Last Name

Phone

Mailing Address

City

State

Zip/Postal Code

Donation Information

Please select whether it is a Checking or Savings account

Account Number

Routing Number

Choosing to donate monthly through automatic withdrawals qualifies you to join our annual giving society, The Circle. If you would like to join, please check this box.

Enrollment Verification

Enrollment and Termination Policy This authorization is to remain in full force and effect until Clarehouse, Inc. has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Clarehouse, Inc. and DEPOSITORY a reasonable opportunity to act on it. For inquiries about termination or adjustments, email [email protected].

By checking this box, you are confirming your understanding of our enrollment and termination policy.

Clarehouse is a 501(c)(3) public charity. We do not receive any county, state, or federal funding or insurance reimbursement. We provide services free of charge, and remain fiscally strong through the generosity of our donors, who value this solution to a very difficult family challenge.