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ContractMarch 30th, 2015
St. Brigid of Kildare Religious Education Program Fee Payment Agreement A family deposit of $20.00 is required Family Name at the time of registration. Address: City: Zip: Telephone Numbers: Home Work: Cell: Tuition Total Tuition Deposit Check # Tuition Balance Due PAYMENT METHOD Please check and complete the financial information, as appropriate. A. Automatic Payment Option 10 Monthly Payments drawn on the 20th of the month - July through April Automatic Method of Payment Checking (please attach VOIDED check) Savings Bank Name: Routing Number: Account Number: Credit Card/Name on card Type of Card: VISA MASTERCARD DISCOVER AMERICAN EXPRESS (circle one) Account Number: Expiration Date: B. Lump Sum Payment Option 1 Payment in full by check or credit card due September 30, 2015 (X) Responsible Party Signature (and authorized signer on account) 3/4/2015 Office Use Only Initials: Received: Processed:
