AUTHORIZATION FOR ONE-TIME WITHDRAWAL
This form can be completed to authorize a one-time withdrawal from a checking or savings account for ordinary gifts/tithe or extraordinary gifts/other, which are gift given in addition to one's tithe. The name and routing number of your financial institution and your checking or savings account number will be needed to complete the form. After submission, you will receive an email confirmation of your authorization for withdrawal.
For what type of gift would you like to authorize a withdrawal from your bank account
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Tithe/Ordinary gift
Extraordinary/Other
*Extraordinary gift is something other than tithe such as the Building Fund, We Care, Capital Campaign, or Memorial.
Is there a specific day (on or after) that you want your gift to be withdrawn
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No, you can withdraw my gift at any time after receiving this authorization
Yes, I would like my gift to be withdrawn on or after a specific date
Specific Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Donor and Account Information & Authorization
Donor/Account Holder Name
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First Name
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Phone Number
Format: (000) 000-0000.
Email Address (required for email confirmation of authorization)
*
example@example.com
Name of Financial Institution (required)
*
Account Type
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Checking
Savings
Routing Number (Required-Financial Institution Routing Number, Nine Numbers)
*
Account Number(required)
*
I/We authorize St. Cecilia Catholic Church to initiate a one-time withdrawal from my/our checking or savings account in the TOTAL amount of:
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Next
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I Agree
Please use this space to include information important to know regarding this one-time withdrawal authorization
By typing your name below, you will be providing an electronic signature verifying and approving details and terms set forth and submitted via this electronic authorization form
Electronic Signature
*
First Name
Last Name
Preview PDF
Submit
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