Partner With us to Reach the Nations
Authorization Agreement for Preauthorized Payments (ACH Debits)
Please print and fill out this form in its entirety and mail to: |
If you have any questions please call us 870.793.9124 |
| Jubilee Family Church Inc. | Office Use: |
Check One:
□ ADD (New Preauthorized Debit Participant) |
□ CHANGE (Financial Institution and/or Account #) |
□ DELETE (Cancel Participation in the Program) |
Note: Due to the time required for company and bank processing, please allow one or two weeks for processing.
I (we) hereby authorize Jubilee Family Church Inc., hereinafter called COMPANY, to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my (our) account indicated below and the depository financial institution named below, hereinafter called DEPOSITORY, to debit and/or credit the same to such account.
Amount to Debit from your Account
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Frequency, Check One |
Depository Financial Institution
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Branch |
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City
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State |
Zip Code |
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Transit Routing Numbers Account Number
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□ Checking □ Savings
This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Please attach a voided check or deposit slip for account validation.
Name(s) – Please Print
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Tax I.D. Number |
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Address
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City/State |
Zip Code |
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Phone
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Signed
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Date |
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Jubilee Family Church thanks you for your continued faithful support of this not for profit ministry. Your gifts are tax deductible.