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EFT Form

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



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:


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