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*

Personal SavingsPersonal CheckingBusiness 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:

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: