ACH Form

Thank you for supporting Community Kitchen through the Automatic Transfer Program! Please complete this form in order to begin your automatic contribution. You may stop this contribution at any time simply by notifying us in writing.
AUTOMATIC TRANSFER AUTHORIZATION -Authorization for Preauthorized Fixed Payments (ACH Debits)
I hereby authorize COMMUNITY KITCHEN OF MONROE COUNTY, INC. to make scheduled withdrawals from the account identified below and authorize the Depository Financial Institution to charge such withdrawals to my listed account.

Each withdrawal shall be equal to

and payable:

If weekly, what day of the week?

If monthly, what day?

The first such withdrawal is authorized for (date):

If the purpose for withdrawals is restricted in any manner, such restriction is stated below. Adjusting entries to correct errors are also authorized. It is agreed that these withdrawals and adjustments may be made electronically and under the Rules of the National Automated Clearing House Association. This authorization will remain in effect until written notice of termination is given to Community Kitchen. I acknowledge receipt of a filled copy of the authorization.

Name of Depository Financial Institution:

Accounts must match!

Routing numbers must match!

Name on Receiving Account: COMMUNITY KITCHEN OF MONROE COUNTY, INC.
Limitations on purpose for withdrawal: Charitable Contribution

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