Direct Debit Form

Secure Online Direct Debit Enrollment

“Where your treasure is, there will your heart be also.” Matthew 6:21
Full Name*

First NameLast Name
Email Address*
example@example.com
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Bank Name*
Bank ABA (Routing Number)*
Bank Account Number*
$100$150$200$250$300$350$400$450$500Other amount of your choosing
Signature*
Privacy Notice: We will not share your information with anyone.
We appreciate your support. We depend on generous people like you to fund the many projects and ministries of St. Mary’s Church. The direct debit program utilizes electronic funds transfer to provide you with a convenient, timely, and accurate method to make your regular donations. Thank you for your generosity!
Enter the message as it's shown*
Should be Empty:

Secure Online Direct Debit Enrollment