Monthly Subscription - Helps Ministries

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Donation/Order ID

Donation Amount*

Donor Information

My Name*

(as appears on bank account)

First Last

Email Address*

Phone Number

Payment Details

Monthly Donation Method

(Please choose one)

Auto Debit (ACH)

Credit Card

Monthly Total

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Payment Details

Credit Card*

Card Details

Cardholder Name

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Payment Details

Name of Banking Institution*

Routing Number*

Account Number*

Type of Account*

Checking

Savings

Preferred Date of Monthly Debit*

10th

25th

Date of First Withdrawal*

Authorization

Terms of Authorization

I hereby authorize Helps Ministries to initiate debit entries to my checking/savings account indicated at the financial institution named above, and to debit the same to such account. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree to contact Helps Ministries if the fund in the selected bank account are or will at any time be sources from financial agencies outside the territorial jurisdiction of the U.S. and provide additional information as requested. I understand that this authorization shall remain valid until it is terminated or revoked in writing, and agree to provide Helps Ministries with an updated Authorization Agreement for Direct Donations to make any changes to my donation amount, financial institution, routing, and/or account number.

I have read and agree to the Terms of Authorization for Direct Donations.

Signature*

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Phone

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