St. Louis Church of Pittsford, New York

 Direct Withdrawal Authorization Agreement

Please complete the Direct Withdrawal Authorization Agreement (below), attach a void check or printed deposit slip and return to Birdie Proctor at the parish office.  If you have any questions, please call Birdie at the Ministry Center 586-5675
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I hereby authorize St. Louis Church of Pittsford, New York, to deposit my regular offertory contribution by initiating credit entries to my account at the financial institution (hereinafter BANK) indicated below.

Regular Offertory

Parishioner Name:__________________________________       Envelope No. _____   
Name (please print)_________________________________      Social Security No. _____________________________
Address__________________________________________       Checking Acct. No. _____________________________
City, State, Zip____________________________________       Savings Acct. No. ______________________________
Telephone No. _______________________      E-mail Address_________________________________
Date to commence:____________________           (Please circle, 15th or 25th of the month)
Monthly Amount:                         $______________________
Quarterly Amount:                       $______________________

This authorization is to remain in full force and effect until St. Louis Church of Pittsford, New York, and BANK have received written notice from me of its termination (when pledge is complete) in such time and in such manner as to afford St. Louis Church of Pittsford, New York, and BANK a reasonable opportunity to act on it.

Signature ___________________________________________                       Date______/_____/_______

(Attach void check or deposit slip here.)