Simply Giving Form Step 1 of 4 25% Name of the organization: Effective date of authorization: MM slash DD slash YYYY Type of authorization: New authorization Change banking information Change donation amount Discontinue electronic donation Change donation date Name First Last Address Street Address City State / Province / Region ZIP / Postal Code Email DATE OF FIRST DONATION: MM slash DD slash YYYY FREQUENCY OF DONATION: Weekly - Mondays Monthly on the 1st Monthly on the 15th FUNDS: General/Operating Funds Building Mission of the Month Other Amounts: Amounts: Amounts: Amounts: CHECKING / SAVINGSPlease debit my donation from my (check one): Savings Account (contact your financial institution for Routing #) Checking Account (attach a voided check below Routing Number (Valid Routing # must start with 0,1,2 or 3): Account Number: I authorize the above organization to process debit entries to my account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the authorization.Authorized Signature: Date: MM slash DD slash YYYY
