electronic Funds transfer

Central Christian College EFT (Automatic Draft) Authorization Agreement


I authorize Central Christian College to initiate monthly electronic debit entries to my checking account indicated below and I authorize the financial institution (BANK) named below to debit these entries from my account. These transfers will occur on the 5th day of each month.

*required fields

*Donor Name:
*Email Address:
*Address:
*City:
*State:
*Zip:
*Telephone:
*Date:
*Financial Institution Name (Your Bank):
*Your Bank's Routing Number:
*Your Account Number:

Monthly Deductions to begin in  (month/year) in the amount of $ ($10 minimum).

This authority shall remain in effect until Central Christian College and BANK have received written notification from me of its termination in such time and such manner as to afford Central Christian College and BANK a reasonable opportunity to act on it, or until Central Christian College or BANK has sent me ten (10) days' written notice of Central Christian College's or BANK's termination. I recognize that I must notify Central Christian College of any change in banks or accounts.

You must include a voided check from this account.  Please fill out the form, print it, then sign below and send it to:

Donor Relations Office
Central Christian College
PO Box 1403
McPherson, KS  67460


__________________________________        _______________
  Signature                                                                      Date