Become a Parishioner

To mail in an ACH Authorization Form click here: ACH Mail in form

To submit electronically fill out form below.

: ACH Authorization Form
: Congregation of St. Genevieve Roman Catholic Church
417 E. Simcoe St.
Lafayette, LA
I (we) hereby authorize the Congregation of St. Genevieve Catholic Church, hereinafter called COMPANY, to initiate a debit entry to my (our) : (Pleae select one.): checking accountSavings Account
: indicate below at the depository financial initiation named below, hereinafter called DEPOSITORY,and, if necessary, initiate adjustments for any transactions credited/debited in error. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. Law.
Depository Name
Branch
City
State and Zip
Routing Number
Account Number
: This authorization is to remain in full force and effect unit COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Full Name
Electronic Signature
Date
Set Amount:
Day of the Month: 1st15th
Transaction Begin Date
Transaction End Date
: Note: In the case of revoked authorization, all written authorization may be revoked only by notifying the originator in writing no later than 15 days before the next transaction effective date.

ACH Corp Authorization Form March 17, 2010 3:11PM
Attachment 8

Are You Still Working?