Common Contracts
1 similar Program Fee Payment Agreement contracts
ContractProgram Fee Payment Agreement • March 23rd, 2016
St. Brigid of Kildare Religious Education Program Fee Payment Agreement A family deposit of $25.00 is required Family Name at the time of registration. Address: City: Zip: Telephone Numbers: Home Work: Cell: Tuition Total $25 Tuition Deposit (circle one) Paid Unpaid 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: (X) Responsible Party Signature (and authorized signer on account) 3/23/2016 Office Use Only Initials: Received: Processed:
