Direct Deposit Authorization
Redeemer Church of Lubbock
P.O. Box 54198
Lubbock, TX 79453
1) Fill out this form with your preferences | 2) Attach a voided check | 3) Mail to the above address
Designation (Check or Fill out Name):
General Tithes & Offerings ____ Ministry of ______
New Authorization ______Change Authorization ______
Depositor’s Legal Name ______
Last First M.I.
Depositor’s Address ______
______
City State Zip
Depositor’s Phone # ______
Depositor’s Bank Name ______
and Address
______
______
City State Zip
______
Bank Routing Number Bank Account Number
Please Credit My
Checking Account: ______Savings Account ______
I hearby authorize Redeemer Church of Lubbock to initiate the following credit entries (or debt entries as adjustments for credit entries made in error) to my above named bank account:
Amount $______Start Date ______
Frequency (Circle One) Monthly: 5th of every month OR One Time
15th of every month OR
25th of every month
**NOTE: MUST ATTACH A VOIDED CHECK**
This authorization is to remain in full force and effect until Redeemer Church of Lubbock has received written notification of change or cancellation.
______
Depositor’s Signature Date