Checking Account Debit Authorization - HDC - Howell Dance Dance Classes Howell NJ, Dance Lessons Monmouth County NJ

Authorize tuition To Be taken out of your checking account monthly
Howell Dance Company

Fields that have an * are required.

Name*
First Last
Address*
Street Address City State ZIP Code
Checking Account Information
Please debit payments from my checking account, below.
Routing Number*
Valid Routing # must start with 0, 1, 2, or 3
Account Number*
Consent – authorization – Howell Dance Company to process debit entries to my account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the authorization.*
I authorize
Consent – same checking account – Howell Dance Company to continue using the same checking account that is already on file from the previous school year.
I authorize
Consent – late fee – that Howell Dance Company will debit my checking account for any outstanding costume, accessory or any competition fees not paid by the due date with a $10 late fee.*
I understand
Upload a photo of a VOIDED check.*
Max. file size: 50 MB.
Your Name – As Your Digital Signature*
Phone
This field is for validation purposes and should be left unchanged.