Automatic Draft Authorization – House to House

Congregation Information

Congregation Name/ID

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Authorization for Automatic Draft

I, the undersigned, hereby authorize House to House automatically draft payment for my invoice(s) from the account I provide. I understand and agree to the following terms:

Payments will be drafted on the 18th of each month or within 3 business days after an invoice is issued, whichever is later.
I agree that it is my responsibility to ensure sufficient funds are available for payment on the scheduled draft date.
If a draft is returned due to insufficient funds, I may be responsible for any associated bank fees.
This authorization will remain in effect until I provide written notice of cancellation at least 15 days before the next scheduled draft.

Account Name Card

Payment Information

Enter information for either ACH or CC, not both.

Bank Account Draft (ACH)
Credit Card

Payment Authorization

Signature

Clear Signature

By signing, I acknowledge that I have read, understood, and agreed to the terms stated above. I authorize House to House to draft payments as described.

Date