Pre-Authorized Debit Donation Form

Parishioner Information
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Envelope #
Donation Amount & Frequency Instructions
The Amount Of
Frequency
- Weekly
- Bi-Weekly
- Monthly
Debit Bank or Credit Card Option
Payment Options
- Bank
- Credit Card
Bank Information
Bank Name
Bank Address
Branch #
Transit #
Account #
Credit Card Information
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Authorization
I authorize Holy Spirit Parish to debit my bank or credit card as per my selections marked above; I understand that I can change or cancel my selections at any time notifing with 30 days the office at Holy Spirit.
Name
First Last
Signature
For Bank Debit Information Please Attach A Void Cheque
Holy Spirit Parish 10827 24 Street SW Calgary AB T2W 2Z2 Phone 403-251-3381

Parishioner Information