Common Contracts
1 similar Authorization Agreement for Automatic Withdrawal of Funds contracts
ContractAuthorization Agreement for Automatic Withdrawal of Funds • April 23rd, 2017
AUTHORIZATION AGREEMENT FOR AUTOMATIC WITHDRAWAL OF FUNDS Effective date of authorization: Type of authorization: □ New authorization □ Change banking information□ Change donation amount □ Discontinue electronic donation□ Change donation date Last Name First Name Address City State Zip Date of first donation: / / Frequency of donation: (check only one)□ Weekly – Mondays□ Semi-Monthly – 15th and 30th□ Monthly on the of each month□ Other - use Special Instructions section Contribution Amount: $ Special Instructions: Please debit my donation from my (check one):□ Savings Account (contact your financial institution for Routing #)□ Checking Account (attach a voided check) Routing Number: Valid Routing # must start with 0, 1, 2, or 3 Account Number: I authorize Turning Point Church to process debit entries to my account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the authorization. Authorized Signature: Date:
