Holy+Family+ACH+Authorization+Form+(003)+2019

Holy Family Church Direct Donation Plan Contributions made by Direct Donation ACH Debit Authorization Form Holy Family Church, 85 North Street, Auburn, NY 13021 is now accepting donation

Holy Family Church Direct Donation Plan Contributions made by Direct Donation (ACH Debit) Authorization Form

Holy Family Church, 85 North Street, Auburn, NY 13021 is now accepting donations and contributions

by direct payment If you are interested in enrolling in this option, please complete the entire form below (two pages) and return it with a voided check or savings account deposit ticket

Name _ Envelope #

Address _

I hereby authorize Holy Family Church, 85 North Street, Auburn, NY 13021, herein after called Church,

to initiate ACH Debit entries to my (our) Checking Account or Savings Account indicated below at the depository financial institution named below, hereinafter called Depository, and to debit the same to such account I (we) acknowledge that the origination of ACH Debit Transactions to my (our) account must comply with the provisions of U.S Law

Bank Name Branch

City State Zip

Routing # Account#

** Please, include a voided Check or Savings Account Deposit Slip with this form **

This authorization will remain in full force and effect until the Church has received written notification from me (or either of us) of its termination in such a manner as to afford the Church and the Depository a reasonable opportunity to act on it

Name(s) Phone # _

Date _ Signature

Note: Accounts will be debited on the first Monday of the period – Weekly or Monthly, whichever you have indicated, or in the case of annual donations on the first Monday of the period after the contribution is scheduled, except when there is a Depository Holiday or Church Holiday on that date, and then it will be the next business day that the Depository or the Church is available

** Please, Note Date automatic transactions should begin **

Date Description Offering

$

Please, fill in the form below for special collections throughout the year.

March Black & Native American Mission $

March Catholic Relief Services Collection $

April Easter Flowers: In Memory of: $

December Christmas Flowers: In Memory of: $