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

There will be 2.2% + 0.30 Paypal transaction fee that will be reduced from the amount you are giving.

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 Represent Christ Wherever We May Be." / "Representamos a Cristo Donde Quiera Que Vayamos".

Authorization Form

Church of the Ascension

Worship Services

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