SPLIT BILLING AGREEMENTSplit Billing Agreement • February 19th, 2020
Thank you for choosing the Boys & Girls Club of the Red River Valley program. Our records indicate that you wish to proceed with split billing arrangements. To implement split billing, each party must agree to the responsible percentage indicated below and identified as Parent/Guardian #1 and Parent/Guardian #2. All information must be completed and signed. Questions about this form can be directed to billing@bgcrrv.org or (701) 235-2147.
