Evangelical Covenant Church
Electronic Funds Transfer Form
Please complete the following form and return to:
ECC-World Mission 8303 West Higgins Road, Chicago IL 60631
Attn: Missionary Support, STM
Name:___________________________________
Address:_________________________________ Phone:_________________
City/State:________________________________ Zip Code:______________
I hereby authorize the business office of the Evangelical Covenant Church to automatically withdraw from my checking account the monthly amount stated below. I understand and accept that this will begin in the month I have stated below and will continue until the Evangelical Covenant Church receives written notification from me stating this automatic withdrawal should be terminated. I also recognize that monthly withdrawals will be made during the last week of each month.
Signature:________________________________ Date:_____________________
Bank and Account Information
Bank Name:______________________________ Phone:__________________
__
City/State:_______________________________ Zip Code:________________
Name on the account:______________________________________________________
Acct #:_________________________________ Routing/ABA#:______________
Giving Information:
Monthly amount to withdraw:______________ Month to start:______________
Account name/number to credit:__STM: Jenifer DeCastro_______________________
Please attach a voided check to this space:
