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If you wish to have your pledge payment deducted regularly from your checking account, please print out this form, fill it in and send to the church along with a voided check from that account. You may also place this information in the Sunday collection basket.
I hereby authorize the Unitarian Society of Germantown to deduct $_________ monthly from my checking account.
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My name as it appears on the account
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Bank name
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Account number
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Bank routing number
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Monthly Withdrawal Date
I have enclosed a VOIDED CHECK to provide the necessary routing information. This authorization will remain in effect until I notify USG in writing to cancel or change the terms or I notify my financial institution at least 3 days before my account is to be charged.
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Signature