GATEWAY CHRISTIAN COLLEGE
5473 Virginia Beach Boulevard • Virginia Beach, Virginia 23462
Toll Free: 1-877-GCC-4FWB • 757-499-3924 • Fax: 757-519-9824
Email: dbarnes@gatewayfwb.org • http://www.gatewaychristiancollege.com
discover the difference . . .
BANK DRAFT AUTHORIZATION
I authorize Gateway Christian College to initiate debit entries or such adjusting entries, either debit or credit which are necessary for corrections, to the account and the amount indicated below and the financial institution named below to credit (or debit) the same to such account. This authority continues until I give written notice to cancel it. (See below.)
Please select the amount of support you would like to provide ...
□ $ 5 Bronze Partner
□ $ 10 Silver Partner
□ $ 20 Gold Partner
□ $ 35 Ruby Partner
□ $ 50 Diamond Partner
□ $100 Platinum Partner
The date you would like the deduction to be made ...
(Please attach a voided account check with this form.)
□ 1st of each month □ 15th of each month
BANK DRAFT AUTHORIZATION
Name_________________________________________________________________________________________________
Address_______________________________________________________________________________________________
City__________________________________________________________ State___________________ Zip______________
Home Phone___________________________________________Business Phone __________________________________
Bank Name____________________________________________________________________________________________
Bank Address___________________________________________________________________________________________
Routing #______________________________________________ Account #______________________________________
Authorization Signature__________________________________________________________________________________
Date Signed_____________________________________ 200______
Please return this completed form to Gateway Christian College at the address above. Thank you for your generosity!