Donation/Order ID Donation Amount*Donor InformationMy Name*(as appears on bank account) First Last Email Address* Phone NumberAccount InformationName of Banking Institution* Routing Number* Account Number* Type of Account* Checking Savings Note: Your financial institution's 9-digit routing number can be found at the bottom of your check (enclosed between symbols), as well as your account number (followed by a symbol).Preferred Date of Monthly Debit* 10th 25th Date of First Withdrawal* Month Day Year 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* Reset signature Signature locked. Reset to sign again CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ