Direct Deposit
Please print and return this form to Farmers State Bank of Hoffman or Trinity Lutheran Church.
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT
TRINITY LUTHERAN CHURCH AND SCHOOL - HOFFMAN, IL
I (We) ____________________________ Hereby authorize Farmers State Bank of Hoffman to initiate debit entries to my (our) account (__)Checking or (__)Savings indicated below at the depository financial institution named below to be credited to the Trinity Lutheran Church & School, Hoffman, Illinois account ________________________.
This debit will take place on the same day each month as indicated until written notice is received from me to revoke said deposit.
_____(monthly _____(weekly) _____(bi-weekly)every 14 days _____(semi-monthly)twice monthly
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PLEASE ATTACH A VOIDED CHECK TO THIS FORM
Bank Name ____________________________________
Bank Routing Number _________________________
City & State ___________________________________
Customer Name _______________________________________
Account Number ____________________ Dollar Amount $____________
Starting Date __________________________
Authorized Signature _______________________________________________
Please return this form to:
Farmers State Bank of Hoffman PO Box 380 Hoffman, IL 62250
or
Trinity Lutheran Church 8700 Huey Rd Box 200 Hoffman, IL 62250