Temple Israel Membership -- Automatic Bank Withdrawal Authorization

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If you want to pay your annual commitment monthly, Temple has an option you may want to use. You can have your commitment payments automatically withdrawn from your checking account every month. You don’t have to remember to write a check! If you would like to take advantage of this time-saving plan, please complete the form below. Once you sign up, your automatic deduction will begin on the 15^th of the month. Questions? Please call Venise Oglesby, Temple Accounting, at 901.937.2775.

* First Name:

* Last Name:

* Cell Phone Number:

* Email Address:

* I (We) authorize Temple Israel to initiate monthly debit entries to my (our) checking account in the following dollar amount for my (our) monthly Temple commitment on the 15th day of each month (please indicate dollar amount):

* I (We) authorize Temple Israel to add my/our $150/year security fee to my/our monthly payment.

Please Select OneYesNo

* Bank's Name:

* Bank's City:

* Bank's State:

Bank's Zip Code:

* Bank's Transit/ABA Number:

* Checking Account Number:

This authority is to remain in full force and effect until Temple Israel and my (our) bank have received written notification from me (or either of us) of its termination in such time and in such manner as to afford Temple Israel and the bank a reasonable opportunity to act on it.

* Signature of Applicant (as it appears on your checking account):

* Date:

Signature of Co-Applicant (if applicable):

Date:

PLEASE PROVIDE TEMPLE ACCOUNTING WITH A VOIDED CHECK IF YOU HAVE ONE -- NO DEPOSIT SLIPS PLEASE.

After you click Submit, you will get an email confirming your submission.

Wed, December 4 2024 3 Kislev 5785

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