Authorization Form for Automatic Contributions to Catholic Social Services

Thank you for your generosity to CSS!

Together, we'll bring Hope In The Good Life to those we serve together.

Please fill out all of the required information. If you have questions, click here to see our ACH FAQ. If you have further questions, please click here to email Michele Birkel or call herĀ at 402.327.6235

Account Information
First Name
Last Name
Address Line 1
Address Line 2
Postal Code
Home Phone:
Cell Phone:
Preferred phone for contact (select one):

Please transfer my donation directly from my:

Need help determining your routing and account numbers? Click here.

Amount and Frequency of Withdrawls
Amount per withdrawl

No file selected

I authorize Catholic Social Services to process debit entries to my account. The authority will remain in effect until I give reasonable notice to terminate this authorization.

Digital Signature: