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Authorization Agreement for Direct Payments (ACH DEBITS) I (we) hereby authorize St. Catherine of Siena Church to initiate debit entries to my (our) checking account or savings account indicated below at the financial institution named below. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. Bank Name: _____________________________________________ Routing Number: _____________________________________________ Account Number: _____________________________________________ Checking Account: (Please attach a voided check) or Savings Account: (Please note if you choose to make your contributions on a monthly basis: Because there are 52 weeks in the year, please consider taking the yearly amount you wish to contribute and dividing it by 12 months. For example: $35 per week times 52 weeks equals $1,820 yearly; $1,820 yearly divided by 12 months equals $151.67 monthly.) Payment Frequency: Weekly: or Monthly: Contribution Amount: Weekly: __________ or Payment Date: Monthly: Weekly: every Friday _ Monthly: __________ 5th or 25th (circle one) Effective Date of first payment: ____________________________ This authorization is to remain in full force and effect until St. Catherine of Siena has written notification from me (us) of its termination in such time as to afford St. Catherine of Siena and the depository a reasonable opportunity to act on it. Name (s): ________________________________ Address: _____________________________________________________________________ Signature: ______________________________ Second Signature: ______________________________ Phone #: Date: ________________ _________________ (if needed for joint account)