To begin sponsorship of a child or give an IGA grant, please fill out the following information. If you would like to sponsor a specific child, include the child's name in the designation area.

Name of Child (optional)

Your Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Donation debited from

Amount authorized to be debited

If other designated gift, please include the amount and how you'd like this donation to be used

Begin my debit on

YYYY

Routing Number

Account Number

By submitting the completed form along with your routing and account number, you are authorizing IOI to draft the fore mentioned amount.

For child sponsorship, your account will be debited on the same day of every month (for monthly supporters) or you may set up annual withdrawals. This will continue until you send us a written notice of cancellation (allow six weeks). Please notify us if you close your account. I (we) hereby authorize Indigenous Outreach International, Inc. to initiate entries to my (our) checking/savings account at the financial institution named. This authority will remain until I (we) notify Indigenous Outreach International, Inc. in writing to cancel it in such time to afford I.O.I. and the financial institute a reasonable opportunity to act upon it. The amount listed above will be debited from my account on the same day of every month or on the next business day thereafter—unless annual debits are preferred.

I agree.