Authorization for Automatic Withdrawal of Contributions
Sign up to electronically automate your contributions to the Church of St. Edward. This form may also be used to change your contribution amount, contribution frequency or bank account information.
Email address
PERSONAL INFORMATION
Last Name
Your answer
First Name
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Phone Number
Your answer
NEW APPLICANTS
New Enrollment
EXISTING USERS
Change in Service
FINANCIAL INFORMATION
Name of Financial Institution
Your answer
Account Number
Your answer
Account Type (check one)
Routing Number: nine-digit code printed on the bottom left side of checks and deposit slips
Your answer
Frequency of Contribution
Amount per Transaction
Your answer
Effective Date
MM
/
DD
/
YYYY
ELECTRONIC SIGNATURE
Authorization
Required
Further Authorization
Required
Your Initials
Your answer
Be sure to click the blue "Submit" button below!
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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