| Elecronic Donation
Payment Authorization
I authorize
______________________________________Church,
to charge
my ATM, debit or credit card 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 ____________ |
Check
Type of Card: |
_______VISA,
___ ____MasterCard, _______Discover
Charges will appear on your card as MyChurchDonations.
|
|
Card Holder's Billing Address for
monthly Card
Statements:
|
_______________________________________________________
Street |
| _______________________________________________________ |
|
City |
State |
|
Zip |
Phone __________________ Email
________________________
Signature _____________________________________________
Date ____________________ |
