I authorize my bank to charge my account and pay the scheduled amounts to Integrative Spirituality in accordance with the terms and conditions written below.

Please indicate the months and amounts of payments to be made by direct withdrawal:

*Amount per month $_____________ o­n the 20th of every month.

*Attach a voided check or a deposit slip printed with your account number.

*Mail the signed form with attached check or slip to mail it to The Integrative Spirituality, PMB 2167 1650 Casino Drive, Laughlin, NV 89029.

*Allow 4-6 weeks for this service to begin. The message o­n your monthly pledge reminder will indicate when your Direct Withdrawal has been set up.