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Recurring ACH Payment Authorization


You authorize regularly scheduled charges to your checking/savings account. You will be charged the amount indicated in your Child Care Fee Agreement each billing period (Weekly). Receipts available upon request and the charge will appear on your bank statement as an “ACH Debit”. You agree that no prior-notification will be provided unless the your weekly copay changes, in which case you will sign a new Child Care Fee Agreement.

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 upon request and upon termination. Any payments not received due to insufficient funds will be subject to a fee equal to any fee CFC, Inc. is charged by our banking institution.

Upload a screenshot of your account and routing numbers from your bank website or a photo of a check.


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