Fellowship French Mission
Pre-authorized Chequing Form
You can make changes or cancel the plan at any time just by writing to the Fellowship Office.
Send the completed and signed form along with a void cheque to:
By Mail:
Fellowship French Mission
PO Box 457
Guelph ON N1H 6K9
By Fax:
519-821-9829
Donor Information
Name:
______________________________________
Mailing Address:
______________________________________
City:
__________________________
Province:
_________
Country:
__________________________
Postal Code:
_________
E-mail:
__________________________
Phone #:
________________
Banking Information
Bank Name:
____________________________________________
Transit #:
______________
Account #:
__________________________
PLEASE ATTACH A VOID CHEQUE
Monthly Gift Designation
Ministry/Fund:
___________________________________
Amount:
$ _____________
Ministry/Fund:
___________________________________
Amount:
$ _____________
Ministry/Fund:
___________________________________
Amount:
$ _____________
Withdrawals to begin (Month/Year):
______________________
I want to be receipted (circle one):
MONTHLY ANNUALLY
Authorization
I hereby authorize The Fellowship of Evangelical Baptist Churches in Canada
to debit my account on the 15th of each month until further notice.