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16166 S. Harrell’s Ferry Road Baton Rouge, Louisiana 70816 225/753.7950 - Fax 225/753.7965

“A Time to Pray…. A Time to Give, 2012 Capital Campaign” AUTOMATIC BANK DRAFT AUTHORIZATION (A SECURE OPTION FOR OUR PARISHIONERS) Name ________________________________________________________________________ Address ______________________________________________________________________ City _______________________________ State ________ Zip Code _____________________ Phone _______________________________ Email ___________________________________

Please automatically draft my account for the Capital Campaign Fund: (Fill in only ONE of these three lines with amount to be debited) $________ each Sunday (weekly) of the month. or $________ 1st Sunday (monthly) of each month. or $________Quarterly

My total pledged amount is ________________________________________ Beginning Date __________________ Ending Date _____________________ Please take my Capital Campaign pledge from my: _____ checking account #_____________________________(attach a voided check) _____ savings account #______________________________(attach a savings deposit slip) I hereby authorize St. Jean Vianney Church to process debit entries to my account. I have attached either a voided check or a savings deposit slip. This authority will remain in effect until I give a two week written notification to terminate this authorization.

__________________________________ Authorized Signature on my account

_______________________ Effective Date


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