Ministers' Transition Fund (Mtf) Authorization Agreement Form For Automatic Debits printable pdf download

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEBITS (ACH DEBITS)

Ministers’ Transition Fund

NAME: ______________________________________________ PASTOR ID NO (if known):________

TAX ID NUMBER: ____________________________________________________________

I (we) hereby authorize NC CONFERENCE OF THE UNITED METHODIST CHURCH (NCCUMC) to initiate debit entries and to

initiate, if necessary, credit entries and adjustments for any debit entries in error to my (our) account indicated below, and the financial

institution named below to debit and/or credit the same to such account.

FINANCIAL

INSITUTION: ___________________________________ BRANCH: ____________________________

CITY: _________________________________________ STATE: _________ ZIP: ________________

ROUTING NO: _____________________________

ACCOUNT NO:___________________________

(9 positions)

Select the type of account being drafted:  Checking  Savings

*If it is a checking account, then please attach a voided check*

Example:

This authority is to remain in full force and effect until NCCUMC has received written notification from me (or us) of its termination

in such time and in such manner as to afford NCCUMC and the financial institution named above a reasonable opportunity to act on it.

NCCUMC reserves the right to adjust the drafted amount in accordance with compensation changes made throughout the year.

** This authorization agreement is automatically renewed each plan year. EXCEPTION: A new form must be completed for

each year for members serving an Extension Ministry, members serving on a less-than-full-time basis, and members on

qualifying types of leave. Forms must be received by January 31st to include twelve (12) payments per plan year.

NAME(S*): ___________________________________________________________________________

DATE: ____________________________

SIGNED X_________________________________

PHONE NUMBER:

SIGNED X_________________________________

EMAIL ADDRESS:

*Two signatures are required for accounts in joint names.

MTF

The plan year is February through January of the following year. For the plan year __________ ** I would like to initiate monthly

Minister’s Transition Fund payments as follows:



Debit my account on a monthly basis in the amount of $________________ per month.

(Total of all payments not to exceed $____________ for the plan year indicated above )

Please circle your desired payment date:

Tenth (10

)

Twenty-fifth (25

)

When this form is completed and signed, mail the form to:

NCCUMC Treasurer’s Office

Attn: JoAnna Ezuka - MTF

700 Waterfield Ridge Place

Garner, NC 27529

NOTE:

We cannot process payments for you for ten days following our receipt of this enrollment form. Please call 919-779-6115 or email

or if you have any questions.

Ministers' Transition Fund (Mtf) Authorization Agreement Form For Automatic Debits

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