Authorization ForM

Please complete this form with a cancelled check or savings deposit slip, placed in an envelope and return it to Cindy Joyce at the church office. If you have questions, contact Cindy at 952-920-0070.

Authorization ForM

Edina-Morningside Community Church		UCC360380
FOR OFFICE USE ONLY	ENVELOPE/DONOR #		DATE

Effective date of authorization: ____________________________
Type of Authorization Form:	q New Authorization q Change donation amount q Change donation date		q Change banking information q Discontinue electronic donation
Last Name			First Name
Address
City			State	Zip
Please debit my donation from my: (check one) q Checking Account (attach a voided check below) q Savings Account (contact your financial institution for Routing #)			Routing Number: _______________________________ Valid Routing # must start with 0, 1, 2, or 3 Account Number: _______________________________
Date of first donation:		donation date:		designated amount (Stewardship):
______/______/______		Monthly on the 15^th		$________________
Agreement I authorize the above church and Vanco Services, LLC to process debit entries to my account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the authorization. Authorized Signature:_____________________________________________________________ Date:________________

Please attach voided check here.

Effective date of authorization: ____________________________

Type of Authorization Form:

q New Authorization

q Change banking information

Last Name

First Name

Address

City

State

Zip

Please debit my donation from my: (check one)

q Checking Account (attach a voided check below)

Routing Number: _______________________________

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

Account Number: _______________________________

______/______/______

Agreement

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