Donation Form - Lighthouse Mission Ministries (Page 3 of 3) in pdf

E LECTRONIC F UNDS T RANSFER A UTHORIZATION A GREEMENT

I ( we) g ive p ermission f or L ighthouse M ission M inistries t o i nitiate d irect p ayments f rom m y ( our)

Checking A ccount t o L ighthouse M ission M inistries.

1. I ( we) i nstruct L ighthouse M ission M inistries t o e nd t he a greement, g iving a 1 0-‐day n otice t o a ct

on m y ( our) i nstruction, o r,

2. L ightouse M ission M inistries o r m y ( our) f inancial i nstitution g ives m e ( us) a 1 0-‐day w ritten

notice t hat t his a greement i s b eing t erminated.

I ( we) u nderstand a nd a gree t hat m y ( our) d onations t o b e i n t he a mount o f:____________

I ( we) w ould l ike t hese t ransfers t o b egin:____________________________________________________

I ( we) w ould l ike t hese t ransfers t o b e: ( circle o ne) M onthly, Q uarterly, A nnually.

My ( our) n ame: ( please p rint)

Name: _ _____________________________________________________________________________________________

Address: _ __________________________________________________________________________________________

City, S tate, Z ip: _ ___________________________________________________________________________________

Phone: _ ____________________ E mail: _ ______________________________________________________________

Signature:___________________________________________ D ate:________________________________________

Please r etain o ne c opy f or y our r ecords a nd m ail o ne t o u s:

Lighthouse M ission M inistries

PO B ox 5 48

Bellingham, W A 9 8227

(360) 6 71-‐1562

All g ifts t o L ighthouse M ission M inistries a nd A gape H ome f or W omen a nd C hildren a re t ax d eductible a s

allowed b y l aw. T his o rganization i s a 5 01(c)3 t ax-‐exempt o rganization. ( Federal T ax I D # 9 1-‐0659437)

Donation Form - Lighthouse Mission Ministries Page 3