Youth With A Mission (BC) Society Project Funding Office

YWAM Project Funding Box 57100 2480 E. Hastings Vancouver, BC V5K 5G6 phone: 604.436.4433 fax: 604.436.4466 email: donorservices@shaw.ca

PRE-AUTHORIZED PAYMENT AGREEMENT

CREDIT VAN CITY

I/We, _________________________________________________________________

authorize Vancouver City Savings Credit Union (VanCity) to debit my/our

account at __________________________________________________

for the amount of ______________________________________/100 dollars

to credit the account of Youth With A Mission (BC) Society.

This authorization is to start in ____________________ (month/year)

and end in _________________(month/year) OR-- continue until further notice

I prefer my withdrawal to be on the:

1st of every month OR--

15th of every month

_____________________________________ Signature Date

**PLEASE FILL OUT PAGE 2 OF FORM H AS THIS FORM IS SENT TO OUR BANK.

TAPE VOIDED CHEQUE HERE (DO NOT STAPLE)

$

OFFICE USE ONLY COMMENTS TO VANCITY

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

Form H Page 1 (Rev 4-09)

Form H Page 2

Youth With A Mission (BC) Society Project Funding Office

(Rev 4-09)

PRE-AUTHORIZED PAYMENT AGREEMENT

Page 2 Date: _____________________

DONOR

Name: _________________________________________________________ Address: _________________________________________________________ _________________________________________________________ _________________________________________________________ Phone #: _________________________________________________________ Email address#: ___________________________________________________

MISSIONARY YOU WANT TO SUPPORT (NAME or CODE)

_______________________________________________________

YWAM Project Funding Box 57100 2480 E. Hastings Vancouver, BC V5K 5G6

phone: 604.436.4433 fax: 604.436.4466 email: donorservices@shaw.ca

In your bank statement when you see a VANCITY withdrawal that is the Pre-Authorized payment from Youth With A Mission.

*You will receive an annual receipt

Please send both Page 1 & 2 of Form H to our office.