Debit Option New Enrollment Account Change Amount Change

5th of every month $

20th of every month $

Every Sunday $

Designation

Date Auto-Debit should begin

Full Name

Address

City

State/Province

Zip Code

Phone

Email

Bank Name

Account Type Personal Checking Account Personal Savings Account Business Checking Account Business Savings Account

Account Number

Routing Number

Driver's License ID

I authorize Lighthouse Tabernacle Church of God to process debit entries to my account as indicated above.
This authority will remain in effect until I give reasonable notification to terminate.

Signature (Full Name)

Submit Reset