Automatic Withdrawal Form

Yes! I want to sponsor a child for summer camp on a monthly basis! I commit to pray for my camper throughout the school year.
Monthly Giving Levels (Check ONE)
Choose how to give:
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
For Automatic Monthly Withdraw
I would like to have this automatically debited from my account on the:
Name(s) on Bank Account (business name if used)
Routing Number
must be 9 numbers - no spaces
Account Number
must be 9-12 numbers - no spaces
Bank Name
Bank Branch
City, State
Type of Bank Account
Bank Phone Number

Area CodePhone Number
Date

MonthDayYear
Date
For Credit Card
Name as it appears on card:
Card Number:
Exp Date:
CVC Code:
Shirt Size
Signature
Enter the message as it's shown
Should be Empty:

For Automatic Monthly Withdraw