Recurring ACH Payment Authorization

 

You authorize regularly scheduled charges to your checking/savings account. You will be charged the amount indicated below each billing period. A receipt for each payment will be provided to you and the charge will appear on your bank statement as an “ACH Debit”. You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

I authorize Commonwealth Family Childcare, Inc. to charge my bank account indicated in this form in the amount of my current weekly childcare fee. In the event my educator is closed, I will be charged the full fee but refunded any overpaid fees within 30 days via ACH to the aforementioned bank account. 

Working On It...