MONTHLY MEMBERSHIP PRE-AUTHORIZED DEBIT FORM

Pre-Authorized Payment Information | Monthly Membership

Monthly Membership

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Monthly Membership Pre-Authorized Payment


Member Name:  

Membership Number:  

Monthly Membership:  

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Authorization

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

  1. Membership withdrawal date on  reflect the pro-rated membership of the month.
  2. Monthly Membership Fees will be withdrawn on the 1st day of each month.
  3. May be cancelled 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.
  5. 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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Document name: Monthly Membership Pre-Authorized Payment
lock iconUnique Document ID: e62854996af544e0d402f4d28c86689918f9bb39
Timestamp Audit
March 29, 2022 5:06 pm PDTMonthly Membership Pre-Authorized Payment Uploaded by Lois Fong - info@je.team IP 24.85.226.252