ELECTRONIC FUNDS TRANSFER (EFT) ENROLLMENT FORM FOR WEEKLY CONTRIBUTIONS
SS. COSMAS & DAMIAN CATHOLIC CHURCH
Please fill out the form below if you want to enroll in this safe program to make a regular offertory contribution to SS. Cosmas & Damian Parish.
My reason for filling out this form is:
I wish to enroll in the EFT Program
I wish to cancel my EFT Enrollment
I wish to change the amount of my EFT
I/We wish to commit to give the following amount of money
We would like the above amount of money taken out of our bank account
WEEKLY (each Friday)
BI-WEEKLY (every two weeks - 26 payments)
MONTHLY (the 1st of the month)
MONTHLY (the Monday after the 15th of the month)
PERSONAL INFORMATION
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
AUTHORIZATION
ALL INFORMATION WILL REMAIN CONFIDENTIAL.
I authorize SS, Cosmas & Damian Parish, 10419 Ravenna Rd., Twinsburg, OH 44087 to automatically withdraw my offertory contribution from my bank.
YES
Bank Name
Bank Account Number
A VOIDED CHECK clearly marked as checking or saving must be sent to the church to provide the necessary routing number. This authority will remain in effect until I notify SS. Cosmas & Damian, in writing, to cancel.
Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: