Direct Giving Enrollment Form I/we will make the following contribution in support of Sts. Peter & George Coptic Orthodox Church. I understand that I may adjust my offering at any time, if necessary, by contacting the church office.(Required) New Authorization Change Donation Amount Change Banking Information Cancellation Donor InformationName(Required) First Last Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Enter Email Confirm Email Donation MethodAccount Type(Required) Checking Account Savings Account Routing Number (9 digits)(Required)Re-enter Routing Number (9 digits)(Required)Account Number(Required)Re-enter Account Number(Required)Donation DetailsDonation Frequency(Required) 1st of the month 15th of the month Donation Amount(Required)Donation Designation(Required)General FundBuilding FundCharity FundYouth FundOrban FundConsentThe benefactor places a high value on the trust and confidence you as the Donor place in us and we consider your privacy our utmost concern. We do not disclose any nonpublic personal information about you to anyone, except as required by the law. We may disclose the information we collect to the financial institutions responsible for the withdrawal of funds from your account via Automated Clearing House (ACH). These companies will use the information only for the services for which we have specified, and are not permitted to use or share this information for any other purpose. AT NO TIME WILL WE RENT OR OTHERWISE MAKE AVAILABLE TO THE PUBLIC OR NONPUBLIC INFORMATION FOR ANY PURPOSE EXCEPT AS DESCRIBED IN THIS NOTICE. If you decide at some point to discontinue the services or become an inactive donor, we will continue to adhere to the privacy policy and practices described in this notice.Consent(Required) I certify that I am authorized to initiate this agreement and that I have read and understand the policies stated above. This authorization will remain in effect until I give written notice for any change or cancellation. I understand there will be a $25.00 non-sufficient funds (NSF) fee charged to my account for any NSF debits.
