Authorization for Auto Draft Authorization Form for Draft of Bank Account or Credit Card This form authorizes Mt. Bethel to draft funds on a monthly basis from your bank account or credit card. The draft will take place around the 20th of each month. Effective Date*Termination DateYou can enter a date that you want the drafts to end, or you can leave it open and just notify us if you want to change the amount or stop the drafts.Account Owner Name*Please give your name exactly as it appears on your accountAccount Owner Email* Account Owner Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Amount per Month*Designation of FundsPlease indicate if you would like to designate any special use for some or all of your funds. If not filled out, funds will be allocated according to the needs of the church.Bank Draft or Credit Card?*Draft from Bank AccountDraft form Credit CardType of Credit Card*VisaMaster CardAmerican ExpressDiscoverName on Credit Card*Credit Card Number*Expiration Date*Card Security Code (CSC)*Bank Name*Bank ABA Routing Number*Name on Account*Account Number*EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.