2024 Electronic Contribution Transfer Authorization

Contact Info

Name(s)

This address will receive a confirmation email

Phone

Address

Commitment Amount to be transferred electronically:

Enter amount:

Please select frequency:

Twice monthly (10th and 20th of each month) Monthly (10th of each month) Monthly (20th of each month) Quarterly (Jan 20, Apr 20, July 20, and Oct 20) Other (enter below)

Other frequency:

PC(USA) Per Capita: # of members x $36.00 (transferred Jan 20, 2024)=

2024 Total amount =

Authorized contribution from:

Checking Account (please send voided check) Savings Account (please send deposit slip) Renewing with no changes (no voided check or slip needed)

Routing #:

Account #:

For checking accounts, please send a voided check to the address below. For savings accounts, please send a deposit slip.

Covenant Presbyterian Church
Attn: Janet Cresson
326 S. Segoe Rd.
Madison, WI 53705

Authorization

I authorize Covenant Presbyterian Church to process debit entries from my account. This authority will remain in effect during 2024 until I give reasonable notification to terminate this authorization or until the last specified payment date (all authorizations expire on Dec. 31, 2024 and must be renewed for 2025).

Signature:

Date

Description

Please fill out this form and click submit.

2024 Electronic Contribution Transfer Authorization

Description

Please Fix the Following