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AUTHORIZATION AGREEMENT FOR ELECTRONIC DEPOSIT |
I (we) hereby authorize the MISSIONARY OBLATES OF MARY IMMACULATE to make electronic deposits to my (our) Checking or Savings account as indicated below:
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(Please send a voided blank check if deposits are to be made to a checking account.) |
| Bank: ______________________________________________________ |
| Routing: ______________________________________________________ |
Bank Address: ______________________________________________________
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| City: _________________________ |
State: _________ |
Zip: ____________________ |
Bank Phone #: ______________________________________________________
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NOTE: This authorization is to remain in full force and effect until the Missionary Oblates of Mary Immaculate have received written notification of its termination. This notification must come from the checking or savings depositor(s) or an authorized individual. This action should be done in such time and manner as to afford the Oblates and the appropriate bank a reasonable opportunity to act
on it. |
Signature(s) _____________________________________________________ |
| Date: _____/_____/_______ |
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