Welcome to UEOG Donations By Regular Deduction From Your Bank Account

  (Who is Happier? The Giver or the Taker ?)

Our Privacy Policy 

  
 

  The fields marked by a * are required information.

  I will make UEOG as Beneficiary in my will. Select Yes or No  *

  Are you a registered member of UEOG? Select Yes or No *

  If so please enter your user name and password below and click here to skip entering your name, address etc. and go to payment information.

  If you are not a registered member click here to skip entering user name and password  

  UserName *

  PassWord *

  If you are not a registered member  you have skipped entering user name and password   

   Enter your First Name

    FirstName *
  
    If you have a Middle Name, enter it first in the 'Last Name' text box below and then enter the Last Name
  
  Enter your last name

   LastName *

   Enter your email address

   Email *

            Enter Number and Name of Street

   NumberAndStreet *

    Enter Apartment Number or Block Number or Block Name or District if it applies, in Street2 and Street3 boxes

   Street2

   Street3

    Enter City

   City *

   Enter Province or State

   ProvinceOrState *

   Enter Postal Or Zip Code

   PostalOrZipCode *

   Enter Country

   Country *

   Enter Telephone Number

    Telephone *

    Since You are a registered member or volunteer you have skipped filing name, address etc.
 
 
            Name of Bank

BankName: *   

Bank Address: Number and Street 

  BankStreet1: *  

Enter Apartment Number or Block Number or Block Name or District if it applies, in Street2 and Street3 boxes
  BankStreet2:   
  BankStreet3:     

Enter Bank City
  BankCity: *     

Enter Bank State or Province  

BankStateOrProvince: *  

Enter Bank Zip or Postal Code

BankZipOrPostalCode: *    

Enter Bank Country
  BankCountry: *    

Enter Bank Telephone Number
  BankPhone: *  

Enter Bank Fax Number

  BankFax: *    
 

Enter Your name as it appears on your check 

  YourNameInCheck: *   

  Enter the amount in decimal value example: 1000.00 (do not enter $ or Rs etc. as the currency is the currency of your country). For example if you are in India and if you enter 4000.00, your donation is 4000.00 Indian Rupees. 

  DecimalAmount: *     

 Enter the Branch Number

  BankBranchNumber: *    

  BankRoutingCode: *     

 Enter the Checking Account Number

  CheckAccountNumber: *  

 

I, with my personal and bank account information as I filled out in this form, authorize my bank to deduct the indicated amount from my indicated bank checking account,  on the   

                  

   st/nd/th of every month, and  pay United Earth Organization, Inc. the said amount.


 

                            ---------------------------------------------------------------                                                    -------------------------                                      

                                                         Signature                                                                                         Date (dd/mm/yyyy)

                                                                                                                                                               

 

Or Please Print this Form, Sign It, Enter the Date  and  
Fax it to the fax number given in
Contact_us

Or Please Print this Form, Sign It, Enter the Date  and  
Mail it to the address given in
Contact_us

 

(Enter the Key of your Digital Electronic Signature in the space below if you have this capability).   What is Electronic Signature?

      with the key of my Digital Electronic Signture being entered below,

  

 

( Choose the date below, if you are entering Electronic Signature above)

 

Date  (Select Date)          /   /


                                  

 

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  Please direct comments or questions to webmaster@ueog.org  or Contact_us