Trinity United Church

Pre Authorized Remittance

Please print this form and then complete the appropriate area and sign at the bottom to authorize your PAR Contributions.

NAME (please print) ______________________________________________

EFFECTIVE DATE _______________________________________________

Check one box only.

□ New PAR Registration

Withdraw $_________ a month from my/our account for the General Fund of Trinity United Church.

Bank Account #: _____________________ Type of Account: __________________

Name of Bank or Trust Company: _________________________________________

Address of Bank or Trust Company: ___________________________________________

To ensure accuracy a sample cheque must accompany this form. (Write "void" across the cheque and leave it unsigned.)

□ Change my PAR as follows: (please indicate any of the following changes)

Change my contributions to $ __________ per month for the General Fund of Trinity United Church.

Change my bank or trust company to: ______________________________________

Name of New Bank or Trust Company: _____________________________________

Address of New Bank or Trust Company: ______________________________________

New Bank Account #: __________________ Type of Account: _________________

If your banking information has changed, a sample cheque must accompany this form. (Write "void" across the cheque and leave it unsigned.)

Please sign to authorize ALL PAR contributions.

Date_______________         
Signature of Contributor ___________________________________

Please return this form in an envelope and place on the offering plate or mail it to Trinity United Church.
THANK YOU!