Direct Deposit Authorization Form


                        Your Name(Required)
                            
                            
                                                    
                                                    First
                                                
                            
                            
                                                    
                                                    Last
                                                
                            
                        
Are you authorized to make billing decisions?(Required)
			
					
					No - If no, do not continue
			
			
					
					Yes
			
Legal Church Name(Required) 
Primary Phone #(Required)
Primary Church Email for Billing(Required)
                            
                        
Church/Society/RR Address(Required)    
                    
                         
                                        
                                        Street Address
                                    
                                        
                                        Address Line 2
                                    
                                    
                                    City
                                 
                                        
                                        State / Province / Region
                                      
                                    
                                    ZIP / Postal Code
                                
                                        
                                        Country
                                    
                    
                
Bank Account #(Required) 
9-Digit Routing #(Required) 
Type of Business Bank Account(Required)
			
					
					Checking
			
			
					
					Savings
			
Copy of Voided Check(Required)Max. file size: 128 MB.
Authorization to Initiate Direct Deposit(Required) I agree to the following
Glad Sound Outreach d/b/a T3CH WORX of AMERICA, LLC. is hereby authorized to directly deposit my pay to the account listed above. This authorization will remain in effect until I modify or cancel it in writing.
Your Signature(Required)
Today's Date(Required)
Email
This field is for validation purposes and should be left unchanged.