We’re BUSTING AT THE SEAMS
“Play4theKids!”
2019 Mountain West CU Association
First Annual Korn Hole Tournament!
ACH Authorization Form
Credit Union: _________________________
Name: _____________________________
Phone #: ____________________________
Email: _____________________________
Please check the items you are purchasing.
( $75 per team of 2
Names: ______________ / _____________
($350.00 for 5 Teams
Team 1: ______________ / _____________
Team 2: ______________ / _____________
Team 3: ______________ / _____________
Team 4: ______________ / _____________
Team 5: ______________ / _____________
( $800 Lane Sponsor
Mail To: Crystal Maldonado / MWCUA Korn Hole Tournament
2020 N. Central Ave., Suite 530 / Phoenix, AZ 85004
E-mail To: cmaldonado@
Fax To: 602 241-9642
-----------------------
ACH Authorization
MWCUA is authorized to withdraw funds from the account of_________________________ CU in the amount of $_________. These funds are to be deposited in the Mountain West CU Association account in payment of registration for the 2019 MWCUA Korn Hole Tournament.
______________________________________________ ___________________________
Authorized Signature Date
*Must be authorized personnel.
................
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