Mission Mississippi
Automatic Gift Withdrawal
Now you can have your monthly donations
automatically withdrawn from your account!
How does the program work?
On the 1st or 15th of each month, Mission Mississippi will withdraw your donation from your bank electronically. The withdrawal will appear on your bank statement and you will receive a tax-deductible donation receipt from Mission Mississippi for each withdrawal.
How do I change my monthly donation amount once I am in the program?
To make any changes to the regular amount of the gift, contact the Mission Mississippi office at least 10 days prior to the scheduled withdrawal date.
What if I need to stop my withdrawals?
Simply call the Mission Mississippi office and let us know 10 days prior to the scheduled withdrawal date.
What if I change banks?
Simply call us to tell us you are changing banks and send a voided check at least 10 days prior to the scheduled withdrawal date.
How do I enroll?
Simply fill out the authorization form below and include a voided check from your checking account. If you are deducting from a savings account, send us a copy of your deposit slip instead of a voided check.
Mission Mississippi
AUTOMATIC GIFT WITHDRAWAL AUTHORIZATION FORM
NAME: ______________________________________PHONE: _______________________________
ADDRESS: _____________________________________ CITY: __________________ STATE: _____
ZIP CODE: _______________________________
E-MAIL: __________________________________________
FINANCIAL INSTITUTION: __________________________________________________________
YOUR ACCOUNT NUMBER: ___________________________________________
BANK TRANSIT/ABA NUMBER_________________________________________
I (we) hereby authorize the Financial Institution named above to electronically debit (my/our)
( ) Checking or ( ) Savings Account $_________________per month.
Deduct on ( ) 1st or ( ) 15th of month.
Beginning in the Month of ______________________________, 20_____
This authority is to remain in full force and effect until Mission Mississippi and Bank have received written notification from me (or either of us) of its termination in such time and in such manner as to afford Mission Mississippi and Bank a reasonable opportunity to act on it. A copy of this completed Authorization Agreement will be provided to the donor and his/her banking institution upon request.
SIGNATURE: __________________________________________________________
DATE: ____________________________
NOTE: A voided check must be attached to this form to verify bank account information.
