Electronic Giving ACH form - Kontaktmission USA

Electronic Giving ACH

Download, print, and mail in this completed donation form
- or -
Complete the following secure online giving form

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

This form is for a: *

Date when you would like this donation to start?

Monthly transfer date: *

? When would you like your support to be debited.

Monthly Donation Amount *

Designate this donation for: *

Please use my donation for the above missionary or project

Bank routing number *

9 digit number on the bottom of your check

Bank account number *

Approval *

I hereby authorize Kontaktmission USA to charge my account each month the amount shown above (this includes my authorization for Kontaktmission USA to reverse any charges made in error). This authority will remain in effect until I give written notice to cancel or change it. I understand that it can take up to three weeks after Kontaktmission USA receives the information before the first electronic gift can be processed and that it can take up to three weeks to process changes.

Signature *

PO Box 825
Humboldt, TN 38343-0825
Email: office@gokmusa.org