Regular Monthly Membership Pre-Authorized Payment

Member Name:  

Membership Number:  

Monthly Membership:  

Membership Discount:  

Class Schedule(s):


Account Holder Information 

Bank Account Holder's Name:




Bank Information (New or updated Information)

Name and Location of Financial Institution:  

Account Number: xxxxx xxx  

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 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: Regular Monthly Membership Pre-Authorized Payment
lock iconUnique Document ID: 87c5a534a172e524acbf3b82f0eca7de6b05517e
Timestamp Audit
March 29, 2022 5:06 pm PDTRegular Monthly Membership Pre-Authorized Payment Uploaded by Lois Fong - IP