RAMADAN MUBARAK! Allah's Apostle said, "When the month of Ramadan starts, the gates of the heaven are opened and the gates of Hell are closed and the devils are chained." [Bukhari]

It is recommended that you attach a voided check to this donation form. A voided check is just a regular check with the

word “VOID” written across it. It has the electronic/magnetic checking account and routing number on it making the

direct deposit process seemless.

Please fill in the following information:

Name [LAST, FIRST]:__________________________________________________________

Street:_______________________________________________________________________

City:_________________________ State:_____________ Zip:____________________

Phone:_____________________ Email:______________________________________

Monthly debit amount $_________________________________________

Account #____________________________________________________

Routing#_____________________________________________________

By signing this document, I authorize ECIC to automatically debit the stated amount from this account owned and

operated by me. I understand that I can, by written notice to ECIC, cancel this arrangement anytime without stating a

reason.

Authorized signature:________________________________ Date:____________________