Bible Education and Missionary Service
Authorization Agreement for ACH (Authorized Clearing House) Origination
“Bank Draft Authorization”
Click here to print this form, then fax it to us at 228-832-1695
or e-mail firstname.lastname@example.org
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.
Your contribution will be withdrawn on the 1st day of the month. If the 1st falls on a Saturday or Sunday of the month, your contribution will be withdrawn on the following Monday.
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 Month of first withdrawal
Office Use Only:
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. If you have questions you can call our bookkeeper at the office at 228-832-1096.