Christian Family Radio
WGNV
Electronic Funds Transfer (EFT) Form

I wish to authorize Christian Family Radio - WGNV (Evangel Ministries, Inc) - to issue an electronic funds transfer from my account for the amount listed below on a monthly basis for deposit into their account at M & I Bank - Fox Valley.

Donor Name(s)  ____________________________________
Address             ____________________________________
City/State/Zip    ____________________________________
Phone Number     Day Time  (     ) __________    Night Time  (     ) __________

Bank Information:  Account Type (Check One)  Checking ___   Savings ___

Bank Routing #      __________
Bank Account #     __________

IF THIS IS FROM A CHECKING ACCOUNT, PLEASE BE SURE TO INCLUDE A VOIDED CHECK SHOWING THE ACCOUNT NUMBER AND ROUTING NUMBER SPECIFIED ABOVE.

Bank Name     _____________________________________________________
Address           _____________________________________________________
City/State/Zip     ____________________________________________________
Phone     (       ) _________________________

Monthly Transfer Amount  $__________  starting (month) ___________ 200__

I understand that the amount above will be withdrawn automatically on or near the 10th of each month until written notice is received by Christian Family Radio to stop.

Signature:     _____________________________     Date:     ____________________

Please return this form with your voided check or savings account information. Mail to:

Kathy Friesen
Director of Accounting
Christian Family Radio
1909 W Second St
Appleton  WI  54914		 The above transaction to your account will be issued on or near the 10th of each month. A Thank You letter will be issued by us after the EFT transfer has been issued. Please be assured that your account information is kept strictly confidential. Please feel free to contact Kathy Friesen, Director of Accounting with any questions or changes at 800-236-9364, extension 20.

Thank you for your support!