Please Initial. I hereby authorize the YMCA of San Diego County to initiate debits to the bank/credit account attached. This authority is to remain in full force and effect until the YMCA or BANK has received the 20 days written notification from me (us) of its termination in such a manner as to afford the YMCA or BANK a reasonable opportunity to act on it. A $ 10.00 service fee will be applied for accounts returned unpaid, closed, or payment stopped. I understand there are no refunds given. I understand it is my responsibility to check my monthly bank statement and report any corrections immediately to the YMCA.
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Samples: Registration Checklist, Registration Checklist, Registration and Consent Forms