Authorization for Automatic Payment
Monthly Contribution
I authorize                                          and the financial institution named here to initiate entries to my
 
checking/savings account.  The authority will remain in effect until I notify                                          in writing to
 
change or cancel it in such time as to afford the financial institution a reasonable opportunity to act on it.  I can stop
 
payment of any entry by notifying my back three (3) days before my account is charged.  I can have amount of an
 
erroneous charge immediately credited to my account up to fifteen (15) days following issuance of my bank statement or
 
sixty (60) days after posting, whichever occurs first.
I understand that it is my responsibility to give advance notice to                                          of any changes to my
account, closing of my account, or change to a different institution.
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I wish to contribute                                          every month to                                         for regular operation
 
expenses.      
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