James North Baptist Church Pre-authorized Donation Form

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James North Baptist Church

500 James St N

Hamilton, ON

L8L 1J4
Name

First NameLast Name
Street Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Home Telephone
Format: (000) 000-0000.
General Fund Amount
Growth Fund Amount
Indicate if you'd like the amount withdrawn on the 1st and/or 15th of the month. I hereby authorize James North Baptist Church to draw the amount indicated above on the 1st or 15th of each month beginning_________________. I understand that this authorization may be cancelled at any time upon written notice.

1st of the month15th of the monthBoth
Signature(s) as required on cheques issued against this account
Second signature if required
Today's date

MonthDayYear
Date
Should be Empty: