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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

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.

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.

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

 
 

 

 

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