Pre-Authorized Debit

Work Entry

PRE-AUTHORIZED GIVING FORM

Thanks for financially partnering with your church through pre-authorized debit giving.

Please fill out in detail the form on this page. If you have any questions, please reach out to info@hopecity.ca.

First Name

Last Name

Email

Phone/Mobile

Campus

Address

Banking Information

Select a choice

Upload an Image of a Void Cheque Provide Banking Details Use Information on File (update amounts only)

Giving Instructions

In the empty fields below, please place the dollar amount you'd like to allocate to each fund (example: $100.00). Leave the field blank if you don't want to allocate any money to a given fund.

General Fund

Building Fund

Missions Fund

Other Designated

Designation Instructions

In the event a designated project is fully funded or funds cannot be expended as designated, they will be allocated to the general fund.

When do you want the funds withdrawn from your account?

Approval

I am authorizing Hope City Church (Edmonton), to debit the above account for the amount and frequencies indicated (or the following business day) until I advise them otherwise.

I may revoke my authorization at any time, subject to providing notice of 15 days. To obtain a sample cancellation form, or for more information on my right to cancel a PAD Agreement, I may contact my financial institution or visit www.cdnpay.ca. I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit www.cdnpay.ca.

Signed

First Name

Last Name

SUBMIT FORM

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