| Electronic
Donation Payment Authorization |
I
authorize ______________________________________________ Church,
to charge my ATM, debit or credit card through
MyChurchDonations.com for my donation(s) as follows: |
|
Initial |
This
one donation only, in the amount of $ ________________ |
|
______ |
Recurring
___ Weekly,
or ___ Monthly
donations in the |
|
|
amount
of $ ______________, until (Date) ____________. |
| ______ |
As
I indicate on Tithe Envelope, until (Date) ____________. |
| Name
on Card ____________________________________________________ |
|
|
Print
Last |
First |
Middle |
| Card Number __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __
__ |
| Expiration
Date ______________ CVV Security Code ___________ |
| Type
of Card: ___ VISA, ___ MasterCard, ___ Discover, ___American
Express |
|
Card Holder's
Billing Address for Debit and Credit Card Statements.
|
_______________________________________________
Street |
| _______________________________________________ |
| City |
State |
Zip |
|
Phone _______________________
Email ______________________________ |
|
| Signature
_______________________________________________________ |
Date
__________________
Charges will appear on your card statement as MyChurchDonations.com. |