Authorization Agreement for Pre-authorized Donations
St. John's Lutheran Church - Le Mars, Iowa
I (we) hereby authorized St. John's Lutheran Church, herinafter called St. John's to initiate debit entries to my (our) account (if possible attach an image of a check or supply bank routing #) indicated below and the donor named below, herinafter calle DONOR, to debit same to such account.
Automated Giving Form
Transit/ABA No.
Frequency of Contribution
Date of First Contribution
Please enter a $ amount next to which funds you wish to donate.
General Fund
Endowment Fund
Capital Fund
General Debt Reduction
Total Giving
I (we) authorize St. John's and Primebank to automatically withdraw offerings/donations from my account.
Yes No
The authority will remain in effect until I (we) provide reasonable notification (12 noon - 2 working days previous to transaction date) to terminate the authorization.
Yes No
Name & Date
Optional Attachment
Description for File
Attach a File