AUTHORIZATION AGREEMENT FOR PRE-AUTHORIZED PAYMENTS (ACH DEBITS)
I/we hereby authorize St. Andrew's Episcopal Church, hereinafter called St. Andrew's to initiate
account (select one) indicated below, and the depository 
debit entries to my/our  
bank or other financial institution) named below, to debit the same to such account as follows:
Amount of $ 
 be drafted 
beginning
Please fill out the following.  Please send a voided check from the account you want drafted to:
St. Andrew's Episcopal Church, 1031 South Carrollton Avenue, New Orleans, LA 70118, Attn: Ruthie Quaglino
DEPOSITORY NAME:
BRANCH NAME:
CITY:
STATE:
ZIP: 
TRANSIT/ROUTING No.
ACCOUNT No.
This authority is to remain in full force and effect until St. Andrew's has received written notification from me (or either of us) of its termination in such time and in such manner as to afford St. Andrew's and the depository a reasonable opportunity to act on it.
NAME:
DATE:
SIGNED:
INSTRUCTIONS: Please fill out this form then print it, sign it, and then mail it along with a cancelled check to:
When you are finished, press the click button to clear your data.
Checking
Savings