Enclosed is my gift for the school: $500  $300  $100  Other

Name Address

City State Zip Code

Email Address

Electronic Funds Transfer (Optional)

I/We would like to make a financial contribution to Corn Bible Academy, P.O. Box 38, Corn, Oklahoma 73024 through an Electronic Funds Transfer (EFT).
This agreement will remain in effect until written notice ahs been given of its termination from the undersigned. Please allow enough time for the financial institution to make the change. A copy of a voided check or deposit slip must accompany this form.

Name of Financial Institution

Type of Account : Checking  Savings
Monthly Withdrawal Amount: 
Beginning: (choose either the 5th or the 20th of the month)  Month Day Year