LHI E-Checking Authorization

Secure Living Hope International, Inc. eCheck Authorization Form
Full Name

First NameLast Name
Short description of how you wish for your gift to be designated:
Name as it appears on your checking account
Bank name
Bank's ABA routing number
Your bank account number
Bank account type
I authorize Living Hope International, Inc. to charge my bank account when requested by me.
For recurring monthly gifts please answer the following questions.
Monthly recurring gift
I authorize Living Hope International, Inc. to charge my bank account on a monthly basis starting on:

MonthDayYear
This payment authorization is valid and to remain in effect unless I notify Living Hope International, Inc. of its cancellation by sending written notice to accounting@lovehopemercy.org
Your mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Full name (Electronic Signature)
Other notes:
Should be Empty: