Competition Team Monthly Pre-Authorized Payment


Member Name:  

Membership Number:  

Competition Training Membership:  

Competition Discount:  

Training Session(s):

 

Account Holder Information 

Bank Account Holder's Name:

Address:  

Phone:  

Remark:  

Bank Information (New or updated Information)

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:

  1. Amount of on the 1st day of each month
  2. Starting Date  
  3. May be cancelled or changed upon 15 days of written notice by me/us being provided to Jeon Eui Taekwondo.
  4. 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, the undersigned, have read, understood, and agree to the terms and conditions of this agreement.

 

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Document name: Competition Team Monthly Pre-Authorized Payment
lock iconUnique Document ID: 67f26d2c7228ab86463d1f515f9ab21de9de4e03
Timestamp Audit
August 8, 2021 5:06 am PDTCompetition Team Monthly Pre-Authorized Payment Uploaded by Lois Fong - info@je.team IP 24.85.226.252