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Holy Family Church Direct Donation Plan Contributions made by Direct Donation (ACH Debit) Authorization Form Holy Family Church, 85 North Street, Auburn, NY 13021 is now accepting donations and contributions by direct payment If you are interested in enrolling in this option, please complete the entire form below (two pages) and return it with a voided check or savings account deposit ticket Name _ Envelope # Address _ I hereby authorize Holy Family Church, 85 North Street, Auburn, NY 13021, herein after called Church, to initiate ACH Debit entries to my (our) Checking Account or Savings Account indicated below at the depository financial institution named below, hereinafter called Depository, and to debit the same to such account I (we) acknowledge that the origination of ACH Debit Transactions to my (our) account must comply with the provisions of U.S Law Bank Name Branch City State Zip Routing # Account# ** Please, include a voided Check or Savings Account Deposit Slip with this form ** This authorization will remain in full force and effect until the Church has received written notification from me (or either of us) of its termination in such a manner as to afford the Church and the Depository a reasonable opportunity to act on it Name(s) Phone # _ Date _ Signature Note: Accounts will be debited on the first Monday of the period – Weekly or Monthly, whichever you have indicated, or in the case of annual donations on the first Monday of the period after the contribution is scheduled, except when there is a Depository Holiday or Church Holiday on that date, and then it will be the next business day that the Depository or the Church is available ** Please, Note Date automatic transactions should begin ** Date Weekly Or Monthly (please circle) Description Sunday Donation Offering $ Please, fill in the form below for special collections throughout the year Date Monthly Monthly Monthly January January January March March March April Description Fuel and Heat St Joseph School Fund Roof Renovations Catholic Courier Journal Solemnity of Mary Initial Offering Ash Wednesday Black & Native American Mission Catholic Relief Services Collection Easter Flowers: In Memory of: Offering $ $ $ $ $ $ $ $ $ $ April April April April May May June June July July August September October November November December December Holy Land / Good Friday Easter Catholic Home Missions Appeal Rice Bowl Propagation of the Faith Mission Ascension Catholic Communication Campaign Holy Father / Peter's Pence Visiting Missionary Emerging Churches Assumption Campaign for Human Development World Mission Sunday Collection All Saints Military Services Collection Catholic University Collection Christmas Flowers: In Memory of: $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ December December Immaculate Conception Christmas $ $

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