ARK OF SAFETY DIRECT DEBIT
AUTHORIZATION AGREEMENT FOR ACH DEBITS
Company Name:
Ark of Safety Christian Church
Company Address:
9402 Marlboro Pike
Upper Marlboro, MD 20772
I (We) hereby authorize Ark of Safety (ASCC), hereinafter called “The Ark” to initiate DEBIT entries to my/our checking account or savings account indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and credit the same to such account.
I (We) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.
___ New ___Increase ___Decrease
Depository Name |
|
|||||||||
Branch |
|
|||||||||
City |
|
|||||||||
State, Zip |
|
|||||||||
Bank Transit/ABA Number 9 digits |
|
|
|
|
|
|
|
|
|
|
Account Number |
|
|||||||||
Total Dollar Amount |
$ __________________ |
Apply $______Tithes $_______ Offering $_______Building Fund |
||||||||
Frequency |
__Weekly start date ________________________ __Bi-Weekly start date ________________________ __1st & 15th start month ______________________ __10th& 25th start month ______________________ __15th & 30th start month ______________________ __Monthly |
|||||||||
This authorization 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 Print) Name as it appears on account |
|
Signature |
|
If Joint Account - Signature |
|
Contact Information: |
|
Phone Number |
|
Address |
|
Email Address |
|
Date Submitted |
|