Credit Card Donation Authorization

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 ________
____VISA, ____MasterCard, ____Discover, ____American Express
Card Holder's Billing Address for Debit or Credit Card Statements:
_______________________________________________________ Street
_______________________________________________________
City		State		Zip
Phone __________________ Email ________________________ Signature _____________________________________________ Date ____________________

Charges will appear on your debit or credit card statement as MyChurchDonations.com