Authorization Agreement for Automated Donation Withdrawls (Ach Debits)

AUTHORIZATION AGREEMENT FOR AUTOMATED DONATION WITHDRAWLS (ACH DEBITS)

COMPANY COMPANY

NAME Yielded Evangelical Servants, Inc. ID NUMBER 54-1558343

I (we) hereby authorize Yielded Evangelical Servants, Inc., hereinafter called COMPANY, to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any entries in error to my/our account as indicated below and the depository named below, hereinafter called DEPOSITORY, to debit and /or credit the same to such account.

U.S. Bank Account Number ______

Check One: ❑Checking Account ❑Savings Account

U.S. Bank ABA Routing Number______

Signature______Date______

Print Name______

Project/Missionary ______

Amount per month ______

(Withdrawals will occur on or around the 20th of each month.)

This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

Please attach a voided check here or ask your bank to provide the information requested.

Please mail to:

Y.E.S.

P.O. Box 700697

St. Cloud, FL 34770

Or scan and email to

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