“A Time to Pray…. A Time to Give, 2012 Capital Campaign”

AUTOMATIC BANK DRAFT AUTHORIZATION (A SECURE OPTION FOR OUR PARISHIONERS)

Name ________________________________________________________________________

Address ______________________________________________________________________

City _______________________________ State ________ Zip Code _____________________

Phone _______________________________ Email ___________________________________

Please automatically draft my account for the Capital Campaign Fund:

(Fill in only ONE of these three lines with amount to be debited)

$________ each Sunday (weekly) of the month.

or

$________ 1st

Sunday (monthly) of each month.

or

$________Quarterly

My total pledged amount is ________________________________________

Beginning Date __________________ Ending Date _____________________

Please take my Capital Campaign pledge from my:

_____ checking account #_____________________________(attach a voided check)

_____ savings account #______________________________(attach a savings deposit slip)

I hereby authorize St. Jean Vianney Church to process debit entries to my account. I have

attached either a voided check or a savings deposit slip. This authority will remain in effect until

I give a two week written notification to terminate this authorization.

__________________________________ _______________________

Authorized Signature on my account Effective Date

16166 S. Harrell’s Ferry Road

Baton Rouge, Louisiana 70816

225/753.7950 - Fax 225/753.7965 www.stjeanvianney.org