| Holy Name Cathedral
Automatic Contribution Enrolment
I would like to donate $_________
per month through an automatic electronic contribution
I have selected the following
payment option:
____Credit Card:
Circle one: [Visa] [MasterCard] [Amex]
Account
number:_______________________________ Expires: (mm/yyyy)
__________
____Automatic Debit to Bank
Account:
Bank
name:__________________________ Account
Number____________________
(please
included a voided check for processing)
Personal Information:
Name:____________________________________
(for credit card charges, name
must be same as on card)
Address:________________________________
City_______________________ State_____ ZIP_______
Phone:____________________________
e-mail: _________________________________________
I authorize Holy Name Cathedral to
withdraw the amount indicated on or about the 15th of each month
until I notify the parish otherwise.
Signature:
___________________________________________________________________________ |