Page 1, E-MIN Automatic Donation Sign-up Form
_________________________________________________________________

Thank you for enrolling in E-MIN's
Automatic Donation Program!

PRINT THIS FORM, COMPLETE IT, AND MAIL IT TO:

E-MIN ADP
P O Box 220
Warrior, AL 35180
_________________________________________________________________

__ Please set up my automatic donation to E-MIN.

   I understand that my future gifts will be drafted or transferred
   automatically from my checking or credit card account on the date I
   choose below.

   I understand that a record of the gifts will appear on my account
   statement and that I can increase, decrease, suspend, or stop giving
   at any time by written notification.

   I understand that my information will be kept private and will not be
   shared.
_________________________________________________________________

My contact information is:

Name    _______________________________________

Address	_______________________________________

	_______________________________________

City	_______________________________________

State	____  Zip ______

E-mail _____________________

Daytime phone  _____________

Evening phone  _____________
_________________________________________________________________

I want to give:

   ___  $5    ___  $35
   ___  $10   ___  $40
   ___  $15   ___  $45
   ___  $20   ___  $50
   ___  $25   ___  $75
   ___  $30   ___  $100

   Other: _______

   On the __ 5th   __15th  __ 25th  of each month
_________________________________________________________________

I want to make monthly automatic donations by (select below):

__ Checking account

   By selecting this box and my signature below, I authorize E-MIN to
   deduct my donation automatically from my checking account each month
   in the amount I have indicated above on the date I have requested
   according to the Terms of Authorization below.

   Checking Account Number:

   _______________________________________

   __ I have read, understand, and agree with the TERMS OF
      AUTHORIZATION on page 2 of this form.


Signature ________________________ Date:_____
(required)

Be sure to enclose a check from this
account for the first month's donation.
_________________________________________________________________

__ Credit card

   By selecting this box and my signature below, I authorize E-MIN to
   deduct my donation automatically from my credit card account each
   month in the amount I have indicated above on the date I have
   requested according to the Terms of Authorization below.

   ___  Visa
   ___  MasterCard
   ___  Discover

   Credit Card Number:

   _______________________________________

   Expiration Date  _________________
   (Month and Year)

   Name and address:  (Please copy this information
   EXACTLY as it appears on your billing statement.)

   _______________________________________

   _______________________________________

   _______________________________________

   ___ I have read, understand, and agree with the TERMS OF
       AUTHORIZATION on page 2 of this form.


Signature ________________________ Date:_____
(required)
_________________________________________________________________

Page 2:, E-MIN Automatic Donation Sign-up Form

PLEASE KEEP THIS PAGE FOR YOUR RECORDS
_________________________________________________________________

   TERMS OF AUTHORIZATION:

   I authorize my bank or credit card company to make the authorized
   deduction(s) or charge(s) until cancelled by me or E-MIN.

   This authorization to charge my bank account or credit card account
   shall be like writing a check to E-MIN or making a charge on my
   credit card, except that it will be done directly.

   I understand that each transaction will appear on my regular bank or
   credit card statement.

   I further understand that this agreement will remain in effect until
   I notify E-MIN that I wish to change, suspend it, or stop it, and E-
   MIN has a reasonable amount of time to fulfill my request.
   Notification should be in writing to:  E-MIN, P. O. Box 220, Warrior,
   AL 35180

   I understand that E-MIN will apply these funds where it deems they
   are most needed to accomplish its ministry goals unless I
   specifically designate otherwise.

   I understand that E-MIN Global Ministries is a 501(c)3 non-profit
   organization and donations to E-MIN are tax deductible in the United
   States.
_________________________________________________________________

CONTACT INFORMATION:

To make changes to your automatic monthly donation to E-MIN, contact
us at:

E-MIN ADP Changes
P. O. Box 220
Warrior, AL 35180

or e-mail us at adpchange@e-min.org
_________________________________________________________________

YOUR AUTOMATIC DONATION DETAILS:

Complete the information you entered on page 1 for your personal records:

   I have set up an automatic monthly donation to E-MIN from my

   __ Checking account.   Number: ______________________

   __ Credit card account.   Number: _______________________

       Type:  __Visa   __MasterCard   __ Discovery

   Amount to be deducted each month:  ____________

   Day of month for deduction:  ___________

   This deduction will begin on ___ (month)  ___ (year)