Choose Your Branch Brandywine Kennett Area Octorara Jennersville Twin Valley West Chester       Change to Draft Information
Please check each item, signifying you agree to the terms.
I hearby authorize my bank to honor my monthly automatic drafts by the YMCA on my account for membership payments. When the bank honors the draft by charging my account, notation on my statement shall constitute by receipt for payment. THIS AUTHORITY IS TO REMAIN IN EFFECT UNTIL REVOKED BY ME IN WRITING.
Check here if your address has changed
YMCA Member Name: (red fields are mandatory)
Street Address: City: State: Zip:
Home Phone: Cell Phone: E-Mail:
	Draft from Bank Account				Draft from Debit/Credit Card Account
	Bank Name:				VISA Expiration Date (MM/YY): Card Number:
	Bank Routing (Transit) Number (9 Digits):
					MASTERCARD Expiration Date (MM/YY): Card Number:
	Bank Account Number:
	Checking Account Savings Account Deposit Slips are not acceptable - verify routing number with your bank
					AMERICAN EXPRESS Expiration Date (MM/YY): Card Number:
	Changes will take effect within 7 business day of form being submitted. Monthly Draft Amount: Click here for monthly membership fees.
	I have read and understand the terms of this EZ-Pay agreement.								ABOUT SSL CERTIFICATES