Electronic Funds Transfer Authorization Procedure

Thank you for your interest in supporting the Fundacion UdG`s  electronic funds transfer (EFT) contribution program.   This program allows you to easily pay your pledge to the University via direct wire transfer, from your bank to our Bank in Costa Rica.    
A minimum of $40 a month is required for participation in EFT.

You can print this form, fill it out, sign it, and give it to your bank.   Please, give your bank a voided blank check for account identification.  The information below is what your bank needs to make the transfer.  They will procede and make the transfer for you.

Fundacion Universidad de Golfito
Account #:         200-02-007-002626-6          SWIFT: BNCRCRSJ
Banco Nacional, Golfito
Costa Rica.

Thank you again for your support through our EFT program.  Please complete and return the form below  to start providing valuable assistance for the Universidad del Pacifico Sur.    Please mail us a copy of this form to:    Fundacion Universidad de Golfito, #4646 Alamedas, Golfito 60701, COSTA RICA.
         
Name _______________________________________________________________________________

Address _____________________________________________________________________________

City _____________________________________  State ______________  Zip ___________________

Phone __________________________________  E-mail _____________________________________ 


I hereby authorize my bank to deduct the following amount from my account and pay the Universidad de Golfito Foundation the amount shown in accordance with the conditions on the upper part of this form and  accept any fees that may be applied by my financial institution for this service.   

Please deduct  $________________ monthly.       Please deduct  $________________ in one single track.

Please direct my contributions to:        Forest Conservation Fund _____________________

                                                                    Scholarship Fund ___________________________
 
                                                                    Research Fund  ____________________________

                                                                    Faculty Fund       ____________________________


Signature ________________________________________________  Date ______________________