AUTHORIZATION AGREEMENT FOR CUC DIRECT AUTOMATIC GIVING
Enroll in CUC Direct and make donating to CUC easier than ever! We'll deduct from your checking or savings account your specified amount at your specified time increment.
Name
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Email Address
Your answer
Phone
Your answer
Please Choose One:
Choose the frequency that you would like your deduction made:
What is your donation amount?
Your answer
How would you like your donation distributed?
Please specify General Fund, Building Fund, or list another. Please also include the percentage of your donation that you would like to go to each fund.
Your answer
What date would you like your donation to begin?
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I (We) hereby authorize Columbine United Church to initiate debit entries to my (our) 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 the ACH transactions to my (our) account must comply with the provision of U.S. law.
Please type your name below. This serves as your electronic signature.
Your answer
I would like my deduction made from my:
(select one)
Bank Routing Number
Your answer
Depository (Bank) Name
Your answer
Checking Account Number
Your answer
Savings Account Number
Your answer
This authorization is to remain in full force and effect until Columbine United Church has received notification from me (us) of its termination in such manner as to afford Columbine United Church and Depository a reasonable opportunity to act on it. I understand that if Columbine United Church wishes to revoke this authorization it will do so in writing to the address on file in the church office.
Please type your name below. This serves as your electronic signature.
Your answer
Today Date:
MM
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DD
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YYYY
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