Automatic Contribution Form

Automatic Contribution Form Please complete this automatic contribution form and return it along with a canceled check or a checking account or savings account deposit slip.

Parishioner Information

Parishioner Name: Street Address: ______

Phone/Cell #: City: ______

Email State: ______Zip: Address: ______

Automatic Contribution Options

□ Weekly Option: I hereby authorize St. Anne Parish to debit my bank account on Monday of each week in the amount of $______for my Parish contribution, starting on _____/_____/_____ (date).

□ Semimonthly Option: I hereby authorize St. Anne Parish to debit my bank account on 1st & 3rd or 2nd & 4th (circle one) Mondays of each month in the amount of $______for my Parish contribution, starting on _____/_____/_____ (date).

□ Monthly Option: I hereby authorize St. Anne Parish to debit my bank account on the 1st, 2nd, 3rd, 4th (circle one) Monday of each month in the amount of $______for my Parish contribution, starting on _____/_____/_____ (date).

I (we) understand that this authorization will remain in full force and effect until I (we) notify St. Anne Parish in writing that I (we) wish to revoke this authorization. I (we) understand that St. Anne Parish requires at least 10 business days prior notice in order to cancel this authorization. My bank information, in regards to the account to be charged, is below as follows:

Bank Bank Address: Name: ______Routing #: ______Account #: ______Account Name:______

Account Type (Circle one): Checking Savings

PLEASE ATTACH A VOID CHECK OR PRE-PRINTED DEPOSIT TICKET FOR VERIFICATION

Your Signature: ______Date: ______Automatic Contribution Form

Is Automatic Weekly Contribution safe? Yes- While writing checks are usually safe, automatic payments are safest. Checks must be passed from hand to hand while being processed making it less secure and more susceptible to check fraud. Automatic payments can eliminate these problems and your account is better protected through the encryption techniques that banks use on-line to secure customers’ information. Automatic payments are the most private, safe, proven way to transfer money.

V O I D

Routing Number Account Number Check Number