Test Form - St. Augustine

Test Bank Automatic Withdrawal Form

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* Indicates required field

Please have

Dollar amount *

automatically withdrawn from my checking account on (choose one).

Withdrawal date(s) *

1st of the month 15th of the month 1st and 15th of the month

I understand that the monies will automatically be deposited in the St. Augustine Church Account and will be credited to me for tax purposes.

Bank Name *

Your Checking Account # *

Name *

First

Last

Signature *

Submit