Name(s)

Address

City

State/Zip Code

State Zip Code

Email Address

Annual Pledge Amount

Installment Type

Weekly Monthly Quarterly Annually

Do you need giving envelopes?

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I/We hereby certify, by checking the box below, that this information is true,
and agree to this sacrificial committment to supporting St. John's Church:

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I/We hereby authorize St. John's Episcopal Church (the Church) to initiate debit (withdrawal) entries, and, if necessary, debit correction and adjustment entries to my/our account at the financial institution listed below:

Account Type

Checking Savings

Name of Financial Institution

Branch Address

Branch City

Branch State/Zip Code

State Zip Code

Routing and Transit Nubmer

Semi-Monthly (5th and 20th days each month)
Monthly (5th day each month)

Signature(s)

(Typing your name(s) above verifies that the above information is true.)