Keeping the Hearthfire Lit
2021-2022 Annual Giving Commitment Form
In support of the vision, mission, programs, and activities of Westside Unitarian Universalist Church, 
I/We commie to make a financial contribution during the 2021-2022 fiscal year, July 1 2021 through June 30, 2022
Name(s):
Phone:
Primary Email:
My/Our total commitment for the twelve-month period is $
I/we will contribute by (circle one): Cash, bank draft, stock
I/we will make payments (circle one): Monthly, quarterly, annually, other:
I/we wish to make a one-time gift to our operating budget in the amount of:
If you are unable to make a financial commitment right now, please check here:
If you are interested in learning more about how to leave a legacy to Westside, check here:
Bank Draft authorization Form:
Note: If you already participate in Westside bank drafting, and your account has not changed, 
you can skip this first section and only fill in the “drafting option and amount” section
Name on Account:
Authorized Signature on Account:
Account Number:
ABA Routing Number (on the bottom of your check): 
Bank address, city, state, zip: 
Account type (circle one): Checking, Savings
Drafting Option and Amount: (if you are using bank draft, you must fill out this section completely)
Monthly (1st): 
Monthly (15th):
Semi-Monthly (1st and 15th): 
Quarterly (1st): 
Drafting to begin on: 
I authorize Westside Unitarian Universalist Church to process debit entries from my account. 
This authority will remain in effect until I give reasonable notification to terminate this 
authorization or until the last specified contribution date.
Signature: 
Last Specified Contribution Date: