Authorization for MNUMC to withdraw funds

This form is to make electronic payments to the MN Conference of the United Methodist Church.

Information as it appears on the account to receive funds:
*Name of church or individual
*Complete address
*Bank routing number

9 digits before the colon

*Bank account number

Digits after the colon

*Type of account
*Amount to be withdrawn
Only number values are allowed
Description of payment
*Frequency of payment
One time only
Monthly for specified number of months
Monthly until authorization is withdrawn
*Number of months
Attach documentation

Scan of a remittance form, invoice, registration form, other.

If you prefer, mail this document to want to: Finance and Administration, Minnesota Annual Conference of the United Methodist Church, 122 W. Franklin Ave., #400, Minneapolis, MN  55404

Attach file pdf, doc(x), xls(x), jpg/gif/png, ppt - up to 25 MB

Contact information for authorized person on account
*I authorize the Minnesota Annual Conference of the United Methodist Church to withdraw funds via ACH from the account and in the amount specified.
*First Name
*Last Name
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