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Competition Team Monthly Pre-Authorized Payment

Member Name:

Membership Number:

Monthly Membership:

Competition Discount:

Training Session(s):

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Address:

Phone:

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Name and Location of Financial Institution:

Account Number: xxxxx xxx

Authorization
I/We hereby authorize Jeon Eui Taekwondo to direct my Financial Institution to debit my/our bank account, on file or indicated above, as follows:

Membership withdrawal date on reflect the pro-rated membership of the month.
Monthly Membership Fees will be withdrawn on the 1st day of each month.
May be cancelled or changed upon 15 days of written notice by me/us being provided to Jeon Eui Taekwondo.
If any payment is returned by the Bank for any reason, I/we will be responsible for Non-Sufficient Funds (NSF) and/or administration charges.
I/We acknowledge that the amounts to be drawn against our Account may vary in accordance with the membership type and condition in the amounts billed Jeon Eui Taekwondo.

I/We, the undersigned, have read, understood, and agree to the terms and conditions of this agreement.

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Timestamp

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August 8, 2021 5:06 am PDT

Competition Team Monthly Pre-Authorized Payment Uploaded by Lois Fong - info@je.team IP 24.85.226.252