PRE- AUTHORIZED BANK WITHDRAWALS FORM

PRINT AND COMPLETE

Please:

Fill in the authorization form (below) and return it with a sample of your cheque marked ``VOID``

Bring the completed form to the parish office. After office hours you can just insert it through the mail opening on the office door.

In case you change your bank or want to discontinue the automatic withdrawals please contact office, 604-298-4144.

Income Tax receipt will be issued for all donations.

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AUTHORIZATION FORM

I choose to donate to St. Helen`s Church by pre-authorized bank withdrawals and hereby authorize the church to automatically withdraw the total monthly amount of (please choose):

$80

$100
$150
$200
OTHER
aprox $20/week
aprox $25/week
aprox $37.50/week
aprox $50/week	Write amount

$
Void cheque attached □

SIGNED:	_________________________________________________________________

NAME: ______________________________________________________________________

MAILING ADDRESS:___________________________________________________________________

CITY ____________________________ PROV ________ POSTAL CODE _____________

PHONE _______________________ E-MAIL ADDRESS_____________________________________

DATE_________________________________

Biba Lupetin

2020-09-18