CHURCH OF ST. ANNE

Make Your Gifts as Automatic as Prayer

Direct Withdrawal Authorization

Name: ________________________________________________ Envelope Number ________

Address: ______________________________________________

City, State, Zip: _________________________________________

I authorize the Church of St. Anne in Wausau, WI to withdrawal funds from my bank account for the following donations approximately the 15^th of every month:

Please indicate the dollar amount.

_______Stewardship Fund

For Special Contributions ie Easter, etc. please send separate check, or let us know when you want us to withdraw from your account.

Begin Withdrawal on: ________________ (name of month)

Signature: __________________________________________ Date: _______________

Bank Name: _____________________________________________________________

Address: _____________________________________________________________

City, State, Zip: __________________________Email Address: _______________________

(for confirmation of withdrawal)

Routing # (9 digit): _________________________________________

Account #: _______________________________

Checking or Savings

PLEASE INCLUDE A VOIDED CHECK WHEN AUTHORIZING FROM YOUR CHECKING. To change amount but not banking information, voided check is not needed.

To make any changes to the Withdrawal Authorization, please send request in writing at least five days prior to the date of the change.