Electronic Giving Form

I authorize my bank to transfer the following amount of money to Campus Outreach each month to support the staff members and ministries listed below.  I understand that this authorization will remain in effect until I give Campus Outreach written notice of change.  I also understand that Electronic Giving is completely voluntary, and I may change or end my participation at any time.

Staff Member or Ministry:                                                               Amount:

___________________________________                      ______________________

___________________________________                      ______________________

___________________________________                      ______________________

                                                                                    

                                                                                            Monthly Total: _________

(If space is needed for additional designations, please attach a plain sheet of paper with the additional entries.)

Please transfer my gift on the: (Circle One)

                   10th of the month                 or                  25th of the month

Name:____________________________________________________________________________

Address:____________________________________________________________________________

City:_______________________________  State:_____________  Zip:_________________

Phone #:____________________________________________________________________________

Email:____________________________________________________________________________

Signature:____________________________________________________________________________

                                                                                     Date: ____________________________

Make the monthly deduction from my: (Circle One)

              Checking Account                          Or                   Savings Account

         (Enclose a voided check)                                        (Enclose a deposit slip)

Please include this form with your next gift or mail to:

Campus Outreach Augusta

642 Greene St.

Augusta, GA 30901