James North Baptist Church Pre-authorized Donation Form

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Return to:

James North Baptist Church

500 James St N

Hamilton, ON

L8L 1J4
Name

First Name Last Name
Street Address
Postal Code
Email
example@example.com
Home Telephone
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Indicate if you'd like the amount withdrawn on the 1st and/or 15th of the month.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 month 15th of the month Both
Signature(s) as required on cheques issued against this account

Clear
Second signature if required

Clear
Today's date

Month Day Year
Date
Should be Empty: