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  • Ekklesia Auto Debit 2

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    ekklesiahattiesburg
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    This document is a credit/debit authorization form allowing an organization called Ekklesia Hattiesburg to initiate transactions from a customer's checking or savings account. It provides the customer's contact information, financial institution details, authorization for transactions and limits, and the customer's signature and date. The form allows the company to debit regular amounts or amounts up to a maximum from the customer's account as specified.

    Original Description:

    Auto Debit form for giving to Ekklesia

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    © Attribution Non-Commercial (BY-NC)

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    This document is a credit/debit authorization form allowing an organization called Ekklesia Hattiesburg to initiate transactions from a customer's checking or savings account. It provides the customer's contact information, financial institution details, authorization for transactions and limits, and the customer's signature and date. The form allows the company to debit regular amounts or amounts up to a maximum from the customer's account as specified.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    41 views1 page

    Ekklesia Auto Debit 2

    Uploaded by

    ekklesiahattiesburg
    This document is a credit/debit authorization form allowing an organization called Ekklesia Hattiesburg to initiate transactions from a customer's checking or savings account. It provides the customer's contact information, financial institution details, authorization for transactions and limits, and the customer's signature and date. The form allows the company to debit regular amounts or amounts up to a maximum from the customer's account as specified.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Ekklesia Hattiesburg

    PO box 641
    Hattiesburg, MS
    39403

    CREDIT/DEBIT AUTHORIZATION FORM

    I (we) hereby authorize ___________________________ (THE COMPANY) to initiate entries


    to my checking/savings accounts at the financial institution listed below (THE FINANCIAL
    INSTITUTION), and, if necessary, initiate adjustments for any transactions credited/debited in
    error. This authority will remain in effect until THE COMPANY is notified by me (us) in
    writing to cancel it in such time as to afford THE COMPANY and THE FINANCIAL
    INSTITUTION a reasonable opportunity to act on it.

    ____________________________________________________________________________
    (Name of Financial Institution)

    ____________________________________________________________________________
    (Address of Financial Institution - Branch, City, State & Zip)

    ____________________________________________ _____________________________
    (Signature) (Date)

    ____________________________________________________________________________
    (Name - PLEASE PRINT)

    ____________________________________________________________________________
    (Address - PLEASE PRINT)

    Set Amount: ____________________ Maximum Amount: _________________________

    Checking/Savings Account Number:____________________________________________

    Financial Institution Routing Number:_______________________________________

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