LHI E-Checking Authorization

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

First Name Last 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 *

Personal Savings Personal Checking Business Checking
I authorize Living Hope International, Inc. to charge my bank account when requested by me. *

I agree
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:

Month Day Year
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

City State / Province

Postal / Zip Code Country
Phone Number *

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