Common Contracts

AUTHORIZATION AGREEMENT FOR AUTOMATIC WITHDRAWAL OF FUNDS

Authorization Agreement for Automatic Withdrawal of Funds • November 19th, 2018

• Contract Type
  Authorization Agreement for Automatic Withdrawal of Funds
• Filed
  November 19th, 2018

FOR OFFICE USE ONLY ENVELOPE/DONOR # DATE Effective date of authorization: / / Type of authorization:  New authorization  Change donation amount  Change donation date  Change banking information  Discontinue electronic donation Last Name First Name Address City State Zip Email Address DATE OF FIRST DONATION: / / FREQUENCY OF DONATION: Monthly on the 5th Monthly on the 20th FUNDS: Regular Sunday Contribution Building & Maintenance Cemetery Scholarship School-Special Gift Youth Ministry Total AMOUNTS:$ $ $ $ $ $ $ CHECKING / SAVINGS Please debit my donation from my (check one): Savings Account (contact your financial institution for Routing #) Checking Account (attach a voided check below) Routing Number: Valid Routing # must start with 0, 1, 2, or 3 Account Number: I authorize the above organization to process debit entries to my account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the au