St. Anthony's Catholic Parish | Register for Pre-Authorized Withdrawal

Name 1st Account Holder *

First

Last

Name 2nd Account Holder

First

Last

Address *

Street, City, Prov, Postal Code

Email Address *

Telephone Number *

Bank Name *

Bank Address *

Bank Number *

Branch Number *

Account Number *

Consent *

Monthly Donation: I (we), as the accountholder(s) authorize St. Anthony’s Parish to debit my (our) account until such time as written notice to the contrary is given by me (us). I (we) am aware that the branch of the financial institution at which I (we) maintain the account is not required to verify that any payment is drawn in accordance with this authorization.

Total Monthly Donation *

Please debit from my (our) account this amount on the first banking day on or after the 20th of each month commencing the month following the date of this form. Please allocate the funds to the following:

Regular Donations

Together In Action

St. Anthony's Food Hampers

Building Fund

Other Donation

Specify Other Donation

Annual Donations

Provide specific instructions for Annual Donation Amounts

Date *

To allow time for processing of changes, I (we) will notify St. Anthony’s Parish of any changes in the account information or the termination of this authorization prior to the 10th day of any month.

Register for Pre-Authorized Withdrawal

Location:

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