This is step 2 of 3. This can be do online or in person. YLS prefers check payments if possible, but can also take Visa and Master Card. Full Name on Card Credit Card Number Expiration Month JanFebMarAprMayJunJulAugSepOctNovDec Expiration Year 2019202020212022202320242025202620272028 Security Number Billing Address City State • Alabama - AL• Alaska - AK• Arizona - AZ• Arkansas - AR• California - CA• Colorado - CO• Connecticut - CT• Delaware - DE• Florida - FL• Georgia - GA• Hawaii - HI• Idaho - ID• Illinois - IL• Indiana - IN• Iowa - IA• Kansas - KS• Kentucky - KY• Louisiana - LA• Maine - ME• Maryland - MD• Massachusetts - MA• Michigan - MI• Minnesota - MN• Mississippi - MS• Missouri - MO• Montana - MT• Nebraska - NE• Nevada - NV• New Hampshire - NH• New Jersey - NJ• New Mexico - NM• New York - NY• North Carolina - NC• North Dakota - ND• Ohio - OH• Oklahoma - OK• Oregon - OR• Pennsylvania - PA• Rhode Island - RI• South Carolina - SC• South Dakota - SD• Tennessee - TN• Texas - TX• Utah - UT• Vermont - VT• Virginia - VA• Washington - WA• West Virginia - WV• Wisconsin - WI• Wyoming - WY Zip Code Checking Account Number Routing Number Name on Check Bank Name Bank Address Authorization AUTHORIZATION - I hereby authorize the credit card company or finical institution named above to debit my credit card or bank account ( if any ) for the term of this agreement, with amount that is due as outlined above, and to make the amount payable to Your Local Savings. This authority shall automatically renew monthly after the first agreement term on a month to month basis, unless given YLS a 30 Day written notice to cancel. I agree that this payment shall be the same as if it were an instrument personally signed by me. This authority is to remain in effect until such time as the terms and conditions of this Agreement have been met. Send Click here for Last step ~~ to complete application Share this:TweetPrintEmailTelegramWhatsApp