Winnetka Congregational Church

ES7288

                  Authorization Agreement for Automatic Withdrawal of Funds

Name (please print)__________________________________________________________________________________________

Address__________________________________________________________________________________________________

City________________________________________________________________State________________Zip_______________

Regular Contributions:

Church Fund

Dollar Amount

Frequency:

Start Date

q Pledge

$____________

q     Monthly -      15^th of each month



____/____/____

q Building Fund

$____________

q Special Event

$____________

Please debit my contributions from my (check one):

q Checking Account – attach a voided check below

q Savings Account – contact your financial institution for the appropriate Routing Number

Routing Number:___________________________________

Valid Routing # must start with 0, 1, 2, or 3

Account Number:___________________________________

I authorize Winnetka Congregational Church and Vanco Services, LLC to process debit entries from my account. I understand that this authorization will remain in effect until I provide reasonable notification of its termination.

Signature:______________________________________________________________________ Date: ___________________.

Please place voided check here.

Winnetka Congregational Church			ES7288
Authorization Agreement for Automatic Withdrawal of Funds

Name (please print)__________________________________________________________________________________________
Address__________________________________________________________________________________________________
City________________________________________________________________State________________Zip_______________
Regular Contributions:
Church Fund	Dollar Amount	Frequency:		Start Date
q Pledge	$____________	q Monthly - 15^th of each month		____/____/____
q Building Fund	$____________
q Special Event	$____________
Please debit my contributions from my (check one): q Checking Account *– attach a voided check below* q Savings Account *– contact your financial institution for the appropriate Routing Number*			Routing Number:___________________________________ *Valid Routing # must start with 0, 1, 2, or 3* Account Number:___________________________________
I authorize Winnetka Congregational Church and Vanco Services, LLC to process debit entries from my account. I understand that this authorization will remain in effect until I provide reasonable notification of its termination. Signature:______________________________________________________________________ Date: ___________________.