Automatic Bank Withdrawal • Connexus Church

Automatic Bank Withdrawal

Fields marked with an * are required.

What would you like to do? *

Set up a new recurring donation

Change an existing recurring donation

Cancel an existing recurring donation

Set Up a New Recurring Donation

Which fund is this recurring donation for? *

Frequency *

Every Week (Friday)

Bi-weekly (every 2nd Friday)

Once a Month (1st)

Twice a Month (1st & 15th)

What date do you want first withdrawal to begin on? *

Your transaction will be processed within 3 to 5 days. Once completed you will receive an email confirming your donation.

Regular Giving Amount

(Use decimal points, e.g. $20.00) *

This is the amount to be withdrawn each time based on the frequency stated above.

Name of Financial Institution *

Branch Transit Number *

Financial Institution Number *

Bank Account Number *

This donation is made on behalf of *

An Individual

A Business

Business Name *

Change an Existing Recurring Donation

Which fund is this recurring donation for? *

Would you like to change the frequency of your donation? *

Yes

Frequency *

Every Week (Friday)

Bi-weekly (every 2nd Friday)

Once a Month (1st)

Twice a Month (1st & 15th)

Would you like to change the amount of your donation? *

Yes

Regular Giving Amount

(Use decimal points, e.g. $20.00) *

This is the amount to be withdrawn each time based on the frequency stated above.

Effective Date *

Date you want the new amount to begin.

Do you need to change the banking information we have on file for you? *

Yes

Name of Financial Institution *

Branch Transit Number *

Financial Institution Number *

Bank Account Number *

This donation is made on behalf of *

An Individual

A Business

Business Name *

Cancel an Existing Recurring Donation

Which fund is this recurring donation for? *

What date do you want the cancellation to be effective on?

Your transaction will be processed within 3 to 5 days. Once completed you will receive an email confirming your donation is cancelled. *

Personal Information

First Name *

Last Name *

If your account is a joint account please add the second person's name.

First Name

Last Name

Address *

Address Line 2

City *

State / Province / Region *

Zip / Postal Code *

Country *

Email Address *

Mobile Number *

Yes! I would like to receive news and information from Connexus Community Church. I understand that this may include promotions and requests for donations.

Yes!

Terms and Conditions

I/we have read and agree to the following conditions: This authorization will be in force until I/we give Connexus Community Church written notice, at least 30 days in advance, to end the PAD (pre-authorized debit), otherwise called automatic withdrawal. I/we may revoke my authorization at any time, subject to providing notice of 30 days. To obtain a sample cancellation form, or for more information on my right to cancel a PAD Agreement, I/we may contact my financial institution or visit www.cdnpay.ca. I/we have certain recourse rights if any debit does not comply with this agreement. For example, I/we have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on my recourse rights, I/we may contact my financial institution or visit www.cdnpay.ca.

Terms and Conditions *

I/we agree with the terms and conditions

I/we DO NOT agree with the terms and conditions