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Gangajali Monthly Recurring Samarpan

What is Gangajali?
Gangajali is a monthly contribution to Hindu Swayamsevak Sangh. Automatic electronic payment can be set up by filling out Gangajali Form through which you are authorizing Hindu Swayamsevak Sangh USA, Inc. to initiate a monthly electronic debit against your bank account.

Personal Details

First Name:

Last Name:

Email:

Billing address details

Street1

Street2

Country

State

City

Zip

Shakha details

Shakha

Vibhag

Sambhag

Samarpan details

I authorize Hindu Swayamsevak Sangh USA, Inc. to initiate either an electronic debit or to create and process a demand draft against my bank account toward my contribution for Gangajali according to the terms outlined below. I acknowledge that the origination of ACH transactions to my account must comply with the provisioning of United States law.

Start date: *

For the monthly recurring amount of:

Bank Name: *

Type of Account:

Checking

Savings

Bank Routing Number

Bank Account Number

This payment authorization is to remain in full force and effect until I notify Hindu Swayamsevak Sangh USA of its cancellation by sending written notice in such time and in such manner to allow both Hindu Swayamsevak Sangh and the receiving financial institution a reasonable opportunity to act on it.

Signature: *

(Note: Typing your name is equivalent to your handwritten signature)

Date: 04-19-2024