ELECTRONIC GIVING
DIRECT DEPOSIT
Credit Card, Debit Card or Echeck
Contacts: Bill Parry, James Mason or Lisa Langdon
NEW HARTFORD FIRST UNITED METHODIST CHURCH
AUTHORIZATION AGREEMENT FOR AUTOMATIC WITHDRAWAL OF FUNDS
Effective date of authorization:__________
Total donation amount: $_________
Type of authorization
New authorization Change donation amount
(Please circle one)
Change donation date
Change banking information
Discontinue electronic donation
Name: _____________________________________________________________
Address: ___________________________________________________________
City: ______________________________________ State:_______ Zip:_________
Date of First Donation: _____________________ Frequency:________________
Funds Usage: General: $________
Benevol. : $________
I authorize New Hartford First United Methodist Church to process debit entries to my bank account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the authorization.
Authorization Signature: ___________________________
Date: _____________
Last four Digits of Account Number: _____________
Exp.Date: _____________
OR
I authorize the New Hartford First United Methodist Church to charge my credit card in accordance with the information above.
Signature (as it appears on the credit card):____________________________
Date: _________
Last four Digits of Account Number: _____________
Consumer Id: _____________
Specific Account Information to be retained by account holder after input:
Bank Account Information
Checking: _____ Savings: _____
Routing #: __________ Account #: ___________
Or
Credit Card Information
Credit Card: Visa: ____ Master Card: ____ Discover: ____ American Exp.: _____
Credit Card Number: _________________________
Exp. Date: ______________
Name On Card: ______________________________
CC Code: _______________
Billing Address (If different from above): _________________________________
Effective date of authorization:__________
Total donation amount: $_________
Type of authorization
New authorization Change donation amount
(Please circle one)
Change donation date
Change banking information
Discontinue electronic donation
Name: _____________________________________________________________
Address: ___________________________________________________________
City: ______________________________________ State:_______ Zip:_________
Date of First Donation: _____________________ Frequency:________________
Funds Usage: General: $________
Benevol. : $________
I authorize New Hartford First United Methodist Church to process debit entries to my bank account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the authorization.
Authorization Signature: ___________________________ Date: _____________
Last four Digits of Account Number: _____________ Exp.Date: _____________
OR
I authorize the New Hartford First United Methodist Church to charge my credit card in accordance with the information above.
Signature (as it appears on the credit card):____________________________ Date: _________
Last four Digits of Account Number: _____________
Consumer Id: _____________