Pre-Authorized Debit
People's Church - 780-481-2244 ext 26
Email *
Church Name *
First & Last Name *
Street *
City *
Phone *
I Would Like To Make The Following Contribution *
Required
CHECKING/SAVINGS (Please debit my (Check One) *
Required
Routing Number (must start with a 0,1,2 or 3) *
Account Number *
I Authorize the above organization And CAFT Services to process debit entries to the above account. I understant that this authority will remain in effect until I provide reasonable notification to terminate the authorization *
Authorized Signature *
Date of Signing *
MM
/
DD
/
YYYY
CREDIT/DEBIT CARD - Please charge my *
Required
Card # *
Name on Card *
Billing Address *
I Authorize the above organization And CAFT Services to process debit entries to the above account. I understant that this authority will remain in effect until I provide reasonable notification to terminate the authorization *
Date of Signing *
MM
/
DD
/
YYYY
Pre-Authorized Payment Date (chose one) *
Submit
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