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Enrollment Form
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Member Enrollment and Authorization Form
Return completed enrollment form to the church office, ATTN: Angela Bruton Office Manager or Pastor Tessaro
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Complete this section for ALL Enrollments(Please print in black ink)
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Check the appropriate box:
( ) New enrollment/authorization
( ) Change in bank account
( ) Change in authorized amount
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Last Name
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First Name
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M.I.
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Mailing Address
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City
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State
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Zip
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Home Telephone #
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Work Telephone #
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Donations/payments should be taken from:
( ) Checking (attach a voided check)
( ) Savings (attach a savings deposit slip)
Routing Number _________________________________________
Valid Routing # must start with 0, 1, 2, or 3
Account Number _________________________________________
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REQUIRED:
I authorize Thrivent Financial for Lutherans and Vanco Services, LLC to automatically withdraw donations/payments from my account. I have attached a voided check or savings deposit slip. This authority will remain in effect until I give reasonable notification to terminate the authorization.
Account Holder Signature ______________________________________
Date ________________________
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* Attach a voided check or savings deposit slip FOR A NEW ENROLLMENT OR CHANGE IN BANK ACCOUNT ONLY
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Complete this section for LutheranCongregation Donations
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Congregation Name: Trinity Lutheran Church
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Street Address: 1415 S Holland Ave
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City: Springfield
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State: MO
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Zip: 65807
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Church Fund Designations:
_________General/Operating_________
_____Building/Debt Reduction
________Repair/Restoration _ ___
_________________________________
_________________________________
TOTAL DONATION AMOUNT
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Amount Per Donation:
$____________
$____________
$____________
$____________
$____________
$___________ (minimum $5)
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Frequency of Donation: (Please check only one)
( ) Weekly on Monday
( ) Weekly on Friday
( ) Semi-monthly (transferred on 1st and 15th of each month)
( ) Monthly on the 1st
( ) Monthly on the 15th
Date of First Donation ______________________________
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Note: The total amount will be transferred based on the frequency selected.
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*** REQUIRED *** MUST BE COMPLETED BY Congregation / Institution
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Congregation / Institution Code 0021178835
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Envelope / Student / Participant Number_________
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Verifier Initials______
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A simple choice; a generous response
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ENROLLMENT INSTRUCTIONS:
1. Using black ink, complete the personal information section including name, address and telephone numbers.
2. Indicate whether this is a new enrollment/authorization, a change in amount, or a change in bank account.
3. Indicate the account type, routing number and account number. Attach a voided check or savings deposit slip to the enrollment form for a new enrollment or change in bank account.
4. Sign and date the Account Holder Signature section.
5. Complete the appropriate section with the institution name and address that will benefit from your giving.
For Your Lutheran Congregation Offering:
· Designate which fund(s) your donation should go to and the amount.
· Select the frequency of your offering.
6. Return the completed enrollment form to the Lutheran congregation, school or institution benefiting from your giving.
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Privacy / Confidentiality: The Authorization Form on the back is seen by the nonprofit Lutheran organizations enrolled in Simply Giving® as well as by the Vanco Services employees who process it. In addition, participant name and address information may be provided to Thrivent Financial for Lutherans. Participant information will not be shared with any other organizations.
|
|
Member Enrollment and Authorization Form
Return completed enrollment form to the church office, ATTN: Angela Bruton Office Manager or Pastor Tessaro
|
|
Complete this section for ALL Enrollments(Please print in black ink)
|
|
Check the appropriate box:
( ) New enrollment/authorization
( ) Change in bank account
( ) Change in authorized amount
|
Last Name
|
First Name
|
M.I.
|
|
Mailing Address
|
|
City
|
State
|
Zip
|
|
Home Telephone #
|
Work Telephone #
|
|
Donations/payments should be taken from:
( ) Checking (attach a voided check)
( ) Savings (attach a savings deposit slip)
Routing Number _________________________________________
Valid Routing # must start with 0, 1, 2, or 3
Account Number _________________________________________
|
REQUIRED:
I authorize Thrivent Financial for Lutherans and Vanco Services, LLC to automatically withdraw donations/payments from my account. I have attached a voided check or savings deposit slip. This authority will remain in effect until I give reasonable notification to terminate the authorization.
Account Holder Signature ______________________________________
Date ________________________
|
|
* Attach a voided check or savings deposit slip FOR A NEW ENROLLMENT OR CHANGE IN BANK ACCOUNT ONLY
|
|
Complete this section for LutheranCongregation Donations
|
|
Congregation Name: Trinity Lutheran Church
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Street Address: 1415 S Holland Ave
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|
City: Springfield
|
State: MO
|
Zip: 65807
|
|
Church Fund Designations:
_________General/Operating_________
_____Building/Debt Reduction
________Repair/Restoration _ ___
_________________________________
_________________________________
TOTAL DONATION AMOUNT
|
Amount Per Donation:
$____________
$____________
$____________
$____________
$____________
$___________ (minimum $5)
|
Frequency of Donation: (Please check only one)
( ) Weekly on Monday
( ) Weekly on Friday
( ) Semi-monthly (transferred on 1st and 15th of each month)
( ) Monthly on the 1st
( ) Monthly on the 15th
Date of First Donation ______________________________
|
|
Note: The total amount will be transferred based on the frequency selected.
|
|
*** REQUIRED *** MUST BE COMPLETED BY Congregation / Institution
|
|
Congregation / Institution Code 0021178835
|
Envelope / Student / Participant Number_________
|
Verifier Initials______
|
|
|
A simple choice; a generous response
|
|
ENROLLMENT INSTRUCTIONS:
1. Using black ink, complete the personal information section including name, address and telephone numbers.
2. Indicate whether this is a new enrollment/authorization, a change in amount, or a change in bank account.
3. Indicate the account type, routing number and account number. Attach a voided check or savings deposit slip to the enrollment form for a new enrollment or change in bank account.
4. Sign and date the Account Holder Signature section.
5. Complete the appropriate section with the institution name and address that will benefit from your giving.
For Your Lutheran Congregation Offering:
· Designate which fund(s) your donation should go to and the amount.
· Select the frequency of your offering.
6. Return the completed enrollment form to the Lutheran congregation, school or institution benefiting from your giving.
|
Privacy / Confidentiality: The Authorization Form on the back is seen by the nonprofit Lutheran organizations enrolled in Simply Giving® as well as by the Vanco Services employees who process it. In addition, participant name and address information may be provided to Thrivent Financial for Lutherans. Participant information will not be shared with any other organizations.
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