Recurring Credit/Debit Card Payment Authorization Form for Kingdom Gymnastics Inc.-Mysite

Recurring Credit/Debit Card Payment Authorization Form for Kingdom Gymnastics Inc.

A receipt for each payment will be provided to you and the charge will appear on your credit card statement. You agree that no prior notification will be provided unless the date or amount changed, in which case you will receive notice from us at least 10 days prior to the payment being collected.

I authorize Kingdom Gymnastics Inc. to make recurring charges to the credit/debit card listed below.

I understand that I will be charged the amount indicated below each billing period.

I authorize Kingdom Gymnastics Inc. to charge my Credit/Debit Card indicated below on the 1st of each month

Recurring monthly fee I agree to be charged (Ex. Gymnastics-$55, Jr. Ninja-$60, Aerial Silks-$100, Tumbling-$55, Parent 'N' Me-$35)

Billing Information

Phone Number

Billing Address

Card Details

Account/CC Number

Expiration Date

CVV

Zip Code

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Kingdom Gymnastics Inc. in writing of any changes in my account information or termination of this agreement. In the event of a weekend or holiday I understand that the payment may be executed on the next business day. I acknowledge that the origination of Credit/Debit card transactions to my account must comply with the provisions of the U.S. Law. I certify that I am an authorized user of this Credit Card and will not dispute these scheduled transactions so long as the transactions correspond to the terms indicated in this authorization form.

Your Signature