I authorize The Country Church to collect
from my account.
I hereby authorize The Country Church, 16975 S. Hwy 211 Molalla, OR 97038 to collect from my account the above amount. By checking the box I acknowledge that my account (
) will be stored and charged as outlined above. Payment is to be made when billed in accordance with the standard policy of the account holders bank. If I need to request a refund, I agree to contact The Country Church as soon as possible to make the request, knowing that there may be circumstances that prevent such a refund from being made.
A receipt was mailed to firstname.lastname@example.org
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