AUTOMATIC BANK DRAFT AGREEMENT Business Office: 1320 Main Street Houston, TX 77002-6803 Office: 832-668-1800 / Fax: 713-752-2316 E-mail ksprague@fmhouston.com First Methodist Houston is requested and authorized to debit your financial institution or to initiate electronic funds transfer on the 15th day of the month beginning _____________________ through December 31, 2014. Amount of monthly withdrawal: $ ________________ _______________________________________ (Authorized Signature – Bank Account Holder)
_______________________________________ (Authorized Signature – Bank Account Holder)
Important: A voided blank check for checking accounts or a deposit slip for savings accounts is required. PLEASE PRINT:
Name(s): Address: Phone Number(s):
Day:
Evening:
E-mail Address: Type of Account:
Checking
Savings
Financial Institution: ______________________________________________________________ Account Number: _________________________ Bank Routing Number: ___________________ Name of Bank Account Holder: _____________________________________________________ Special Instructions: _______________________________________________________________ If you have any difficulties or questions, please call the Finance Office at 832-668-1826.
H:\ACH Contributions\Automatic Bank Draft Form Revised.doc