Page 1 of 1

Authorization Agreement for Direct Payments

General Fund

Crosswinds Church

8106 31st Avenue NW • Oronoco, MN 55906 • 507-289-7937 •

Withdrawal Information

This is a request to have funds withdrawn from my specified account twice a month, on or about the 2nd and 4th Thursdays of each month, and

transferred to the specified account for Crosswinds Church. To change or cancel this authorization, Crosswinds Church will need written notification on

an authorization form. Allow 2 weeks when requesting a change or cancelling this service. Please return this completed form to the church office

for processing.

1. This is a (choose one): □New Request □Change to a previous request □Cancellation of a previous request

2. Type of Account to withdraw funds from: □Checking □Savings

Name as it appears on the account __________________________________________

Routing number for ACH transactions __________________________________________

Usually the first series of numbers found on bottom of your check

Account Number __________________________________________

Name of Financial Institution __________________________________________

Address of Financial Institution __________________________________________



Date of first withdrawal __________________________________________

Amount of withdrawal: $_________________________________________

3. I the undersigned hereby authorize the ACH (Automated Clearing House) transactions to be initiated and processed to my accounts indicated below.

I further authorize and consent the named financial institution to release information about my account to Think Federal Credit Union in order to carry

out my instructions for the ACH transfer. I have read and understand the terms and conditions provided. This authorization will remain valid until Think

Federal Credit Union, Crosswinds Church, or I revoke it. I acknowledge that the origination of the ACH transaction to my account must comply with

the provisions of U.S. law and ACH regulations.

×_______________________________ _________________ _______________________________

Signature of Account Owner