First Unitarian Church of Rochester

First Unitarian Church of Rochester Name Total annual amount pledged: $______Automated Contribution Authorization Address To be paid in equal installments of ______$ ______. City, State, Zip Thank you for fulfilling your pledge by using ______Name automated payments. This option can help by Payments to be made: Name______and Routing Number of bank or credit union reducing paperwork and establishing a regular ______Address ______monthly City, State payment schedule without the need for bills or ______City, State, Zip +4 checks. quarterly (Jul., Oct., Jan., and Apr) Checking______Account Number annually in: Name and Routing Number of bank or credit union To set up automated payments, please Month ______complete the Automated Payment I authorizeCity, State the First Unitarian Church of Rochester ______Authorization Form to the far right and to deduct this amount monthly, quarterly or annually fromChecking my account Account until I Numbernotify them of a change. return it to the church office along with a Questions voided check from your account. The middle Total annual amount pledged: $______section is for your reference. Please contact Al Gundlach, the Finance and I authorize the First Unitarian Church of Rochester Database Director with any questions or To beto paid deduct in equal from installmentsmy account betweenof: changes. To discontinue EFT, we ask you July 1, 2008 and June 30, 2008. Payments will be debited from your checking to notify us 30 days in advance of the next monthly scheduled withdrawal. Total amount quarterly pledged: (July, $______Oct., Jan., and April) account according to your payment schedule. Annually in ______Your monthly bank statements will show the To be paid in equal installments(Month) of : transactions. monthly First Unitarian Church of Rochester quarterly (July, Oct., Jan., and April) 220 Winton Road South Annually in . If you change banks, accounts, or need to ______Rochester NY 14610-2956 (Month) change your automated payment for any reason, Signature Date please contact the Finance and Database Director, Al Gundlach, at 271-9070 x 103 or [email protected]. First Unitarian Church of Rochester Telephone: 585-271-9070 ext. 103 ______Email: [email protected] Signature Date Thanks again for your pledge. First Unitarian Church of Rochester Pledge Drive 2008-2009

Please keep this section Please attach a voided check and return to for your records. theThank church you office.for fulfilling your pledge by using your credit card. This option will help you and ______Please attach a voided check and return to the church office by June 1, 2008 Automated Payment Authorization

FIRST UNITARIAN CHURCH

220 Winton Road South Rochester, NY 14610-2956

Phone: 585-271-9070 Fax: 585-244-5391