Autopay – White Rock Montessori

How would you like to make your tuition payment(s)?*

The first tuition due date for the 2020-2021 school year is June 1, 2020.

I have read and agree to these terms for tuition autopay in the amounts indicated on my child's Enrollment or Re-Enrollment Contract.*

To properly affect the cancellation of these charges, I am required to give 10 days written notice.

I hereby authorize White Rock Montessori to initiate credit card charges to the below-referenced credit card account on tuition plan due date(s).

I acknowledge and agree to pay the 2.65% processing fee associated with credit card charges.

I hereby authorize White Rock Montessori to initiate debit entries to the below-referenced checking or savings account on tuition plan due date(s).*

To properly affect the cancellation of these charges, I am required to give 10 days written notice.

I have read and agree to these terms for tuition autopay in the amounts indicated on my child's Enrollment or Re-Enrollment Contract.

Account Holder Name*

For the account to be used for tuition autopay

First Last

Account Holder Phone Number*

For the account to be used for tuition autopay

Account Holder Address*

Debit/Credit card to be used for tuition autopay

Street Address Address Line 2 City State ZIP Code

Debit/Credit Card Number*

Debit/Credit card to be used for tuition autopay

Debit/Credit Card Expiration Date*

For the account to be used for tuition autopay

Bank or Credit Union Name*

For the account to be used for tuition autopay

Routing Number*

For the account to be used for tuition autopay

Account Number*

For the account to be used for tuition autopay

Electronic Signature*

Please type your first and last name to serve as your electronic signature.

Your Email Address*

(to receive confirmation of tuition autopay setup)

Enter Email Confirm Email

Additional Email Address (Optional)

Where you would like a copy of your email confirmation sent.