Authorize tuition To Be taken out of your checking account monthly
9/2024 – 5/2025

You must upload a photo of a Voided Check at the end of this form.

Fields that have an * are required.

"*" indicates required fields

Student's Name*
Name On The Bank Account*
Address*

Checking Account Information

Please debit payments from my checking account, below.
Valid Routing # must start with 0, 1, 2, or 3
Consent – authorization*
Consent – late fee*
Max. file size: 50 MB.
This field is for validation purposes and should be left unchanged.