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Auto-draft Authorization

Please provide the following information:

I authorize bank drafts on the above account in the following amount per month. I understand that if I wish to change or stop automatic drafting of my account, I must notify the church in writing 10 days prior to the draft date.

$ per month
My automatic drafts will begin on
The autodraft will begin in the following month, and repeat on the same day of each month thereafter.

I wish to allocate the specified amounts as follows:

$
$
$
$
$