PRE-AUTHORIZED CONTRIBUTIONS FROM BANK ACCOUNT

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* 1. I (we) hereby authorize GracePoint Baptist Church to debit the following bank account for a contribution of the following dollar amount:

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* 2. This is to occur on the following dates:

1st of every month

16th of every month

1st and 16th of every month

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* 3. Please specify the way you would like the above amount designated:

General Fund - $

Kingdom Seeds - $

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* 4. Name of Bank:

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* 5. Account Number:

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* 6. Transit Number:

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* 7. For verification purposes please upload a picture of your personal cheque (unsigned and marked VOID).

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 8. Name & Address:

Name (as it appears on cheque) *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

You the Payor may revoke your authorization at any time, subject to providing notice of 21 days. To obtain a sample cancellation form, or for more information on your right to cancel a PAD Agreement, contact your financial institution or visit www.cdnpay.ca.

You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, contact my/our financial institution or visit www.cdnpay.ca.

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* 9. I/WE have read and understood the terms of this authorization and acknowledge receipt of a copy thereof.

Please TYPE your name(s) below as an electronic signature.

Signature:

Signature (if applicable):

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* 10. Date of signing:

Date:

Date

PRE-AUTHORIZED CONTRIBUTIONS FROM BANK ACCOUNT

Question Title

* 1. I (we) hereby authorize GracePoint Baptist Church to debit the following bank account for a contribution of the following dollar amount:

Question Title

* 2. This is to occur on the following dates:

Question Title

* 3. Please specify the way you would like the above amount designated:

Question Title

* 4. Name of Bank:

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* 5. Account Number:

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* 6. Transit Number:

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* 7. For verification purposes please upload a picture of your personal cheque (unsigned and marked VOID).

Question Title

* 8. Name & Address:

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* 9. I/WE have read and understood the terms of this authorization and acknowledge receipt of a copy thereof. Please TYPE your name(s) below as an electronic signature.

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* 10. Date of signing:

* 9. I/WE have read and understood the terms of this authorization and acknowledge receipt of a copy thereof.

Please TYPE your name(s) below as an electronic signature.