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TUITION AUTOPAY AUTHORIZATION
PLEASE CHECK ONE:
__________ New Enrollment. Complete all information below.
__________ Change of Information. Complete all information below.
__________ Delete Enrollment.
Please delete my enrollment in the Tuition Autopay program effect ___________
Signed _______________________ Date ________________
You must notify Sheboygan Christian School if any information changes regarding your bank account or if you would like to change the account or financial institution from which your automatic payment is debited. To request a change or to discontinue services, notice must be submitted in writing to Sheboygan Christian School. Please allow 15 days for enrollment activation or for any changes or deletions to become effective.
NEW ENROLLMENT AND CHANGES:
Account Holder’s Name: _______________________________________________________
Deduct $______________________ From Account # __________________________
This is a __________ Checking Account __________ Savings Account
Name of Bank ________________________ Transit Routing # _________________________
Deduction to be made on the __________1st day of each month OR the __________15th day of each month
(In the event that the 1st or the 15th falls on a weekend or Holiday, the deduction will be made on the next business day.)
Date of first deduction ____________________________________
PLEASE INCLUDE A COPY OF A VOIDED CHECK FOR CHECKING ACCOUNTS OR A DEPOSIT SLIP FOR SAVINGS ACCOUNTS.
I hereby authorize Sheboygan Christian School to make withdrawals from the account listed above. These funds will be applied toward my tuition payments.
Signed ________________________________ Social Security #_________________________
Print Name ___________________________________ Date_________________
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