Authorization for ACH Withdrawels (Debits)

Authorization for ACH Withdrawels (debits)

Please complete the process of enrolling in auto-payments via ACH payment process. This eliminates the need to mail paper checks.

Authorization for ACH Withdrawels (Individuals, Businesses, or User Groups) to The River Conference

Authorization Agreement for Automatic Withdrawels (ACH Debits)

Date(Required)

What type of entity are you authorizing payment be made by?

Church

Vendor or User Group

Individual

Church Name

Vendor or User Group

Your Name(Required)

Prefix First Middle Last Suffix

You are entitled to authorize and submit the information required to establish this ACH withdrawal process.

Email(Required)

Enter Email Confirm Email

Banking Information

This is establishing a New ACH or Updating a Current ACH

NEW

UPDATING

Is this a BUSINESS or PERSONAL account?

Business

Personal

Type of Account the ACH Debits Monies From

Approved Amount to Be Debited Monthly (withdrawn)

Name on Bank Account (List the name of the Church, Business or Individual which is named on the bank account)

Bank Name

Bank Address

City State / Province / Region ZIP / Postal Code

Routing Number(Required)

Confirm Routing Number(Required)

Account Number(Required)

Confirm Account Number(Required)

In Full Force

This authority is to remain in full force and in effect until COMPANY has received written notification from the CHURCH, BUSINESS, or INDIVIDUAL of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

The River Conference of the Free Methodist Church

23300 Cypresswood Drive Spring TX 77373-9406 [email protected]

Authorization for ACH Withdrawels (Debits)