KHCB Automatic Donation Form

This page is to make a request for KHCB to automatically withdraw funds from your bank or creditor to the KHCB ministry. This transaction will be set up as a monthly event, and once your information is entered in the system, an amount, set by you, will be automatically transfered from your bank to KHCB.

Click here to see terms and FAQ concerning Automatic Donations

In order to make an automatic monthly donation from your account, please print this page, fill out the information, and send it by mail to KHCB.

1. Please debit the following monthly amount: $_________________

2. I would like my Automatic Contribution Transfer to take place on (circle one):

The 5th of the month or The 20th of the month

3. Please complete this information.

   Name: ___________________________________________________

   Address: _________________________________________________

   City, St, Zip: ______________________________________________

   Phone: __________________________________________________

   E-Mail: __________________________________________________

   Signature: _______________________________________________

   Date:____________________________________________________

For Checks:

Please include a voided check with this form.

For Credit Cards:

Circle Card Type: Master Card or VISA

Enter Card No.:_______________________

Enter Exp. Date:______________________

For security precautions, please enter your card's CVV number (the 3 digit number on the back of the credit card) here:

CVV Number:__________