I hereby authorize  ___________________________________ (my bank)

to automatically transfer funds rom my account to

The St. Francisville Chamber of Commerce as follows:

 

 

From Account

___________________________________ (Account name)

___________________________________(Account number)


Amount of transfer:  $______________

Frequency of transfer:   weekly    / monthly

Start Date:  ______________________________

Stop Date:  ______________________________






________________________________________________________________________
Authorized Signature                                                                                     Date