ACH Authorization

AUTHORIZATION AGREEMENT FOR ACH DEBITS
I (we) authorize Heart of the Bride Ministries, Inc. (HOB) to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my/our Checking or Savings account [select one below]. I authorize the depository named below to debit and/or credit the same to such account on the 15th of each month. Once submitted, I understand that I can only adjust or cancel my donation in writing through mail to the Heart of the Bride home office or by emailing holly@heartofthebride.org. Please indicate the type of account:*

CheckingSavings
Frequency:*

MonthlyOne Time
If monthly; please start my ACH withdrawal on the 15th day of (if blank, withdrawal will happen on the next 15th day of the month):
Month
Bank Name*
City*
State*
Routing/ABA Number*
Account Number*
Amount (Please designate below)*
Designation (where the above donation should go):

Should add up to the total above
Specific Missionary Name: missionary Amount
Child Sponsorship Country:    country     Amount
Location Sponsor Country:   country     Amount
HOB General Fund Amount:   Amount
Sponsored child or Other:   indicate child, trip, project, etc.       Amount
If for a Mission Trip:   Who are you supporting?
This authority is to remain in effect until HOB has received written/email notification of its termination in such time as to afford HOB and DEPOSITORY a reasonable opportunity to act.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
**If household, please include both husband and wife information.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date*

MonthDayYear
Date
Type Name
Signature

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AUTHORIZATION AGREEMENT FOR ACH DEBITS
Should be Empty:

AUTHORIZATION AGREEMENT FOR ACH DEBITS

Designation (where the above donation should go):

AUTHORIZATION AGREEMENT FOR ACH DEBITS