Parish of Saint Bernard of Clairvaux
Parishioner Name:
__________________________________________________________________
Social Security Number:
_____________________________________________________________
I (We) hereby authorize The Parish of Saint
Bernard of Clairvaux, hereinafter called the PARISH,
to initiate debit entries to my (our) checking/savings account indicated below and the depository named
below,
hereinafter called the DEPOSITORY (BANK) to debit the same to such account.
DEPOSITORY NAME (BANK NAME):
__________________________________________________
BRANCH:
__________________________________________________
CITY:_________________________________
STATE:______________ZIP:______________
YOUR ACCOUNT NUMBER:
__________________________________________________
BANK TRANSIT / ABA NUMBER:
___________________________________________________
PLEASE CHECK ONE:
|
WEEKLY OFFERING:___________ AMOUNT:___________(To be settled each
Wednesday) BI-MONTHLY OFFERING:_________AMOUNT:____________(To be settled the
10th and 25th of each month) MONTHLY OFFERING:________AMOUNT:____________(To be settled the 5th
of each month) This authority is to remain in full force and effect until the PARISH
and DEPOSITORY (BANK) have received written notification from me (or either of us) of its
termination in such time and in such manner as to afford the PARISH and DEPOSITORY (BANK) a reasonable opportunity to act on it.
Holy days, Easter, Christmas or special offerings such as the annual
Seminarian Collection. Please consult your monthly envelope package for dates and envelopes
for these offerings.) |
NAMES:__________________________________or_________________________________
(please print) (please print)
SIGNATURES:______________________________or_________________________________
SOCIAL SECURITY
NUMBERS:___________________or_________________________________
DATED:_____________________________
PLEASE INCLUDE A VOIDED CHECK OR DEPOSIT SLIP
FROM YOUR DEPOSITORY
(BANK) INSTITUTION.