One-Time or Periodic Automatic Debit Form

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- I hereby authorize the Fellowship of Christian Airline Personnel to initiate monthly debit entries to my checking or savings account indicated below at the depository financial institution named below, hereafter called DEPOSITORY, and to debit the same such account. These debits will occur on or around the 5th of each month. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.
- This authorization form remains applicable for any verbal or written requests from me for a donation to be debited at a future date.
- This authorization form is applicable only for this one-time donation.
Name*
First Last
Your Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
This account is:*
- Checking
- Savings
Amount to be debited:*
Depository Name:*
Branch:*
Bank Address:*
City State / Province / Region ZIP / Postal Code
Bank Routing #:*
Account #:
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- I understand that my account will be debited upon receipt of this request. I further understand that I can withdraw this permission by notifying the Fellowship of Christian Airline Personnel International Office in writing.
Date*
MM slash DD slash YYYY
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