AUTHORIZATION FORM

CONGREGACION LEON DE JUDA ES11333

FOR OFFICE USE ONLY ENVELOPE/DONOR # DATE

Effective date of authorization: ____________________________

Type of Authorization Form:
New Authorization
Change banking information

Change donation amount
Discontinue electronic donation

Change donation date
Last Name First Name

Address

City State Zip

Please debit my donation from my (check one): Routing Number: ____________________________

Valid Routing # must start with 0, 1, 2, or 3

Checking Account (attach a voided check below)

Savings Account (contact your financial institution for Routing #) Account Number: ____________________________

DATE OF FIRST DONATION: FREQUENCY OF DONATION: (check only one) FUNDS AND AMOUNTS:

Weekly on Mondays
Building Fund $_________
nd th
______/______/______
Semi-monthly on the 2 and 16
Tithes and Offerings $_________
th

Monthly on the 16
Restricted Gift1 $_________
nd nd nd

Quarterly (Jan 2 , April 2 , July 2 , and
nd
Oct. 2 )
Total $ ________

SPECIAL INSTRUCTIONS:
Note 1: Please write below the name of the Ministry or person for whom you’re donating this restricted gift:

ANNUAL CONTRIBUTIONS:
Special Offering $__________________ Transferred on ______/______/______

AGREEMENT
I authorize Congregación León de Judá and Vanco Services, LLC to process debit entries to my account. I understand that this
authority will remain in effect until I provide reasonable notification to terminate the authorization.

Authorized Signature:_____________________________________________________________ Date:________________

QUESTIONS? Please email us at prosantuario@cljmail.org or call us at 617.541.4455 x16.

Please attach voided check here.