Authorization Form

Name of Organization:

Effective Date of Authorization:

Type of Authorization:

New Authorization

Change Donation

Change Donation Date

Change Banking Information

Discontinue Electronic Donation

Last Name:

First Name:

Address:

City:

State:

Zip:

Email Address:

Date of First Donation: Frequency of Donation: Funds: Amounts:

Weekly - Mondays

Semi-Monthly - 1st & 15th

Monthly on 1st

Monthly on the 15th

Annual Giving

Facility Reserve Fund

Pay by Debit, Credit Card or Paypal Account

I authorize the above organization to process debt entries to my account. I understand that this authority will remain in effect until I proide reasonable notification to terminate the authorization.

"We are ambassadors who represent Christ." – 2 Corinthians 5:20

Authorization Form

Church of the Ascension

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