I (we) hereby authorize Lutheran Life Villages to initiate entries to my (our) checking/savings account at the financial institution indicated below. This authorization will remain in effect until I provide written notification of its cancellation to LLV’s finance department, allowing sufficient time for the financial institution to act on the request. I understand that I can stop payment of any entry by notifying my financial institution 3 days before my
account is charged. I also authorize any entry required to correct the deduction in the event of error.

Note: The transaction name may be shown on your bank statement as Lutheran Homes, Inc.

Regular Payment Date: 20th of each month