EFT manual setup

Print this page, complete the information, attach a voided check or savings deposit slip and return to the Bridge. It may be returned

	with the information cards on Sunday morning
	or mailed to: the Bridge: Eastgate Christian Church / PO Box 1635 / Benicia, CA 94510
	or faxed to: (707) 747-5532

Eastgate Christian Church	ES4606
Member Authorization Form Effective Date:__________	check one: □ New Authorization □ Change Contribution Amount □ Change Financial Institution Account □ Discontinue Electronic Contribution
Amount: General Fund $_________ Building Fund $_________ Total: $_________	check one: □ Weekly (transferred on Mondays) □ Semi-Monthly (transferred on the 1^st & 15^th) □ Monthly (transferred on the 15^th)
Name on Account (Please Print):
Address:
City:	State:	Zip:
Please take my contribution directly from the account specified: □ Checking Account (attach a voided check) □ Savings Account (attach a savings deposit slip)
Account #:	Routing #: Routing number must start with 0, 1, 2, or 3. It is 9 digits long, & is located at bottom of check between these symbols \|: \|:
I authorize the Bridge: Eastgate Christian Church to process debit entries to my account. I have attached a voided check or savings deposit slip. This authority will remain in effect until I give reasonable notification to terminate this authorization. Authorized signature on my account: date:
Please attach a voided check or savings deposit slip.