Christian Family Radio
WGNV
Electronic Funds Transfer (EFT) Form
I wish to authorize Christian Family Radio - WGNV (Evangel Ministries, Inc) - to issue an electronic funds transfer from my account for the amount listed below on a monthly basis for deposit into their account at M & I Bank - Fox Valley.
Donor Name(s) ____________________________________
Address
____________________________________
City/State/Zip
____________________________________
Phone Number Day Time
( ) __________ Night Time
( ) __________
Bank Information: Account Type (Check One)
Checking ___ Savings ___
Bank Routing # __________
Bank Account # __________
IF THIS IS FROM A CHECKING ACCOUNT, PLEASE BE SURE TO INCLUDE A VOIDED CHECK SHOWING THE ACCOUNT NUMBER AND ROUTING NUMBER SPECIFIED ABOVE.
IF THIS IS FROM A SAVINGS ACCOUNT, YOU WILL NEED TO GET THE ROUTING NUMBER AND ACCOUNT NUMBER FROM YOUR BANK DIRECTLY AND INCLUDE IT WITH THIS FORM.
Bank Name
_____________________________________________________
Address
_____________________________________________________
City/State/Zip
___________________________________________________
Phone
( ) _________________________
Monthly Transfer Amount $__________ starting (month) ___________ 200__
Please continue this authorization: (Please check one)
_____ Through October 31, 2003 _____Until Further
Notice
Signature:
_____________________________ Date:
____________________
Please return this form with your voided check or savings
account information. Mail to:
Kathy Friesen
Director of Accounting
Christian Family Radio
1909 W Second St
Appleton WI 54914
The above transaction to your account will be issued between the 10th and the 12th of each month. A Thank You letter will be issued by us after the EFT transfer has been issued. Please be assured that your account information is kept strictly confidential. Please feel free to contact Kathy Friesen, Director of Accounting with any questions or changes at 920-731-6320 or 800-236-9364.
Thank you for your support!