MOUNT HOPE CHURCH OF CHRIST

MISSIONS AUTO CONTRIBUTION AUTHORIZATION FORM


RE: HUFF’S OCEANIA MINISTRY



Check one:


New enrollment.  Complete, sign and return this form with a voided check.


Cancel enrollment.  Sign and return this form.


SECTION A – APPLICANT INFORMATION

Last Name (as it appears on account)

First Name

Middle Initial

If joint account, list other names

Current Street Address

City/State

Zip

Home Phone

SECTION B – BANK ACCOUNT INFORMATION

Bank Name

Routing Number

Account Number

Check one:

         Checking Account          Savings Account


I hereby authorize and request Mount Hope Church of Christ (organization) and the financial institution listed above to debit the indicated bank account in the amount of $ on the  15 th day of each month.


I understand that I may terminate this agreement by giving notice to organization.  I may do this at any time in writing, but must allow a reasonable amount of time after receipt for the organization to act upon it.  



CONTRIBUTOR’S SIGNATURE DATE


X


Please mail to: 

Oceania Missions

Mt Hope church of Christ

2830 Mt Hope Rd

Webb City, MO  64870


Or 

Oceania Missions

Jason Huff

2730 E 24th St

Joplin Mo  64804