St. Joseph Parish
ACH CREDIT/DEBIT AUTHORIZATION FORM

I (we) hereby authorize St Joseph Parish (THE CHURCH) to initiate entries to my checking/savings accounts at the financial institution listed below (THE FINANCIAL INSTITUTION), and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until St Joseph Parish is notified by me (us) in writing to cancel it in such time as to afford St Joseph Parish and THE FINANCIAL INSTITUTION a reasonable opportunity to act on it.

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(Name of Financial Institution)

________________________________________________________________
(Address of Financial Institution - [ ] Branch, City, State & Zip)

________________________________________________________________
(Signature)                                            (Date)

____________________________
(LAST 4 DIGITS OF SOCIAL SECURITY NUMBER)

________________________________________________________________
(Name - PLEASE PRINT)

________________________________________________________________
(Address - PLEASE PRINT)

Debit
Set Amount: ______________

FREQUENCY: 1ST Monday of the month __________

or 1ST AND 3RD Monday of the month __________

Checking/Savings Account Number: ________________________

Financial Institution Routing Number: _______________________
(Look between these symbols l: :l on the bottom left of your check)

Please attach a voided cancelled check below and thank you for your contributions.
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PLEASE NOTE: This form is to be used by parishioners who want to give electronically. Please call the rectory with any questions, and thank you for your continued support.