Divine Mercy Congregation
Parishioner Electronic Giving Authorization Form
 

Instructions:

1.        Complete the parishioner name & address information

2.        Designate whether this is a new authorization, change in authorization amount or change in the account information.

3.        Select giving frequency and enter a start date (if selecting monthly, make sure to check which date you want the transaction made).

4.        Designate total giving by specific fund.  The direct payment program enables you to contribute to your choice of general parish fund or utilities/building maintenance fund.

5.        Designate account type, routing number and account number. 

6.        Sign on the authorized signature line.

7.        If this is a new authorization or a change in account, make sure to attach a voided check or a savings deposit slip.

8.        Place your completed form into a sealed envelope and mark it “Electronic Giving” and return it to the parish office (or place in the collection basket).

9.        A photocopy of this form will be mailed to you for your records after it is processed in the office.

 If you have any questions about the Electronic Giving Program or this form, please call Chris Fleming at         762-6810 ext 109, for additional information.   If you continue to use your offering envelopes during Mass, please indicate on the envelope “Electronic Giving”.

 Parishioner Name (please print ­­­­­­­_____________________________________________________________________________________ City _____________State ase call Chris Fleming at 762-6810, extension 109

 Address______________________________________ City ­___________________________State______ Zip________     

 

 New Authorization                         Change in Authorization                         Change in Account Info

Text Box: FREQUENCY
 
  Weekly (will be transferred on Mondays)
 
  Semi-Monthly (will be transferred the 1st & 15th
                                          of each month)
 
 Monthly (will be transferred on either the 
                 1st or the 15th of each month – 
                 indicate choice of date below)
                 transfer on the 1st
                 transfer on the 15th
                                                
If no date is filled in, the 
first transaction will be on
Start Date ___________   the next applicable transfer 
                                           date. 
Text Box: GIVING DESIGNATION
 
Fund:                    Amount:
 
General                               $_________
 
Utilities /                              
Building Maint.     $_________
 
                              
                             $________ Total Contribution Amount
 
 
Contributions may be divided between the funds listed.  Contact the parish office for details.

 

 

 

 

 

 

 

 

 

 

Please deduct my contribution directly from my:

   Checking Account (attach a voided check)                                Routing # _____________________________________________

                                                                                           Checking Account # _____________________________________

Or

   Savings Account (attach a savings deposit slip)      Routing #______________________________________________

Account #_______________________________________

I authorize Divine Mercy Congregation to process debit entries to my account listed above.  I have attached a voided check or savings deposit slip.  This authority will remain in effect until I give reasonable notice to terminate this authorization.

 

Authorized signature on my account _________________________________________________________________