Pledge Partners Application Form

Now you can join Mid-Ohio FoodBank's Pledge Partners program online. Just fill in the required information and click the "submit" button. Your information will be kept secure and safe and will be viewed only by the Foodbank.

 Monthly Donations

 Thank you for your interest in Mid-Ohio FoodBank's Pledge Partners program.  We appreciate your generosity.

I want to become a member of the Pledge Partners program by pledging a tax-deductible monthly gift.

Contact Information

Name (Required):            

Company Name:            

Address (Required):        

City/State/Zip (Required):

Home Phone:                

E-Mail Address:             

Donation Information
Amount you would like to donate monthly:
(Minimum $10 per month)

   New participant
   Change of accounts and / or financial institution

Checking Account Information

   I would like to use the checking account option.

Routing Number:                
(lower left hand corner of check)

Checking Account Number: 

Debit Date:                        

Credit Card Information

I would like to use the credit card option.  Mid-Ohio FoodBank accepts Visa, MasterCard, and Discover Card.

Credit Card Type:          

Credit Card Number:      

Expiration Date:           (MM/YY)

Debit Date:                        

Authorization Statement (Required)

By submitting this form, I authorize Mid-Ohio FoodBank to debit my account electronically or charge my credit card each payment period.  This authority will remain in effect until I have signed a new authorization, or upon cancellation of participation.  I (we) agree to fully comply with all aspects of U.S. law.

                                                               I Agree

Cancellation

If at any time you wish to stop your contribution to Mid-Ohio FoodBank, please provide a fifteen-day written notice to:

Mid-Ohio FoodBank
Attn: Pledge Partners
1625 West Mound Street
Columbus, OH  43223

Additional Information

 Please acknowledge my gifts:  

Please check how often you would like to receive our appeals:

                        

Acknowledgment of your donation will be mailed to you.

Security note: This is a secure page which you can verify by the fact that the address in your browser above begins with an "https" rather than an "http".  Also, a lock icon should appear in the lower right corner of your browser when you are on a secure page.  Logos and other graphics are considered "insecure" items.  If we included them, you would receive a warning that this page contains both secure and insecure items.  While such a warning would not mean that the page is unsecured, we decided to avoid it by disabling our logo and other graphics on this page.  The information you enter on this page is secure.

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