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Divine Mercy
Congregation 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 _______________________________________________________________________ Address______________________________________ City ___________________________State______ Zip________
New Authorization Change in Authorization Change in Account Info
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 _________________________________________________________________
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