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 (please check one) *
Required
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.
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