5851 GA Hwy 85, Riverdale, GA 30274
Phone: (770) 907 - 7102
HTAManager@hindutempleofatlanta.org
Tax ID: EIN-58-1602137
Temple Timings
Daily 9:00 AM - 900 PM

Pre-Authorized Payment Form
Download pdf version at HTA_BankAutoDeduction.pdf

AUTHORIZATION AGREEMENT FOR PRE-AUTHORIZED PAYMENT
COMPANY NAME: HINDU TEMPLE OF ATLANTA, INC. ID NUMBER: 58-1602137


I (we) hereby authorize THE HINDU TEMPLE OF ATLANTA, INC. to initiate monthly debit entries to my (our) Checking account indicated below and the Bank named below, Hereinafter called DEPOSITORY to debit the same to such account.

DONORS BANK NAME (DEPOSITORY)   _______________________________________________

CITY   ___________   STATE   ________   BRANCH  ____________   TRANSIT/ABA NO.   _____________

ACCOUNT NO.   __________   AUTHORIZED DEBIT ENTRY AMOUNT $ __________

This authority is to remain in full force and effect until COMPANY and DEPOSITORY have received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

DONOR'S NAME   ___________________________________   DONOR'S SS#   ______________________

DATE   __________________   SIGNED   ____________________________________



* PLEASE ATTACH VOIDED CHECK OR DEPOSIT SLIP