Bible Education and Missionary Service
             Authorization Agreement for ACH (Authorized Clearing House) Origination
                                        “Bank Draft Authorization”

I hereby authorize Bible Education and Missionary Service, (228) 832-1096, hereinafter called BEAMS, to initiate debit/credit entries and to initiate, if necessary, debit/credit entries and adjustments for any debit/credit entries in error to my _____Checking or _____Savings (select one) indicated below and the depository named below, hereinafter called Depository, to credit and/or debit the same of such account.

I understand that if I request a Stop Payment to be placed on a debit/credit entry due to circumstances not created by BEAMS, I will be responsible for any charges associated with said Stop Payment.

Name of Your Bank (Depository) _____________________________________________________

City_______________________ State ________Phone____________________________________

Name (Church) on Account _________________________________________________________

Your Account Number _____________________________________________________________

Transit/Bank Routing Number _______________________________________________________

Monthly Contribution $_________________ Bibles
Monthly Contribution $_________________ BEAMS Missionary (name)
Monthly Contribution $_________________ Ministry Needs
Monthly Contribution $_________________ Other
Thank you for your generous contribution. It is understood that if a specific need has been met, then excess funds will be used where needed in the BEAMS ministry.

Day to withdraw funds each month (1-30) If the day you choose falls on a Saturday or Sunday of the month, your contribution will be withdrawn on the following Monday. If no day is chosen, we will withdraw your contribution on the 1st day of the month.

This authority is to remain in full force and effect until BEAMS has received WRITTEN notification from me of its termination in such time and in such manner as to afford BEAMS and Depository a reasonable opportunity to act on it.

This authorization is not valid unless accompanied by a Voided Check or a Copy of a Savings Card.


____________________________________               _________________________________
PRINT NAME                                                    SIGNATURE 

_________________________________                   _________________________________
DATE                                                              Date of first withdrawal

Office Use Only:

Received____________________      

Notes _____________________________________________________________________________

Copy and Paste this form into a word document, print, fill out all information and then mail the form to BEAMS, P.O. Box 10200, Gulfport, MS 39505 or fax to (228) 832-1695