St. Thomas United Church – PAR (Pre-Authorized Remittances) Authorization Form

(For new PAR donors and any banking changes)

PAR Congregational Number: 10010800

I / We: (required)

Address: (required)

Phone #: (required)

Hereby request and authorize The United Church of Canada on behalf of St. Thomas United Church – 100 Hawkwood Boulevard N.W. Calgary, Alberta T3G2S9

To debit my account on the 20th day of each month the amount of $as a contribution by me to St. Thomas United Church with allocations as follows:

•Local Operating Fund $
•United Church of Canada Mission & Service Fund $
•Building & Mortgage Fund $

Cheque Information: St. Thomas Office Administrator will contact you directly for Financial Account information including:
• Financial Institution Number, Transit/Branch Number, Account Number
• A sample unsigned cheque marked “VOID” to ensure accuracy

I may revoke my authorization at any time, subject to providing notice of 15 days to the St. Thomas United Church Office Administrator

The use, retention an disclosure of personal information collected from this form is done in compliance with privacy legislation, including but not limited to Personal Information Protection and Electronic Documents Act (2000,c.5)