Automatic Payments Authorization

I authorize Cherry Preschool to debit/charge my:(Required)

Checking Account

Savings Account

Credit Card

Credit Card Number(Required)

Expiration Date:(Required)

mm/yyyy

CVV(Required)

Bank Name(Required)

ABA/Routing Number(Required)

Account Number(Required)

Account Holder - Name as it appears on the bank account/credit card(Required)

First Middle Initial Last

Address on Account(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Student's Name(Required)

First Last

Do you have another child at Cherry?(Required)

Yes

Student's Name(Required)

First Last

Message (optional)

I hereby authorize Warren W. Cherry Preschool (FEIN 36-3809526) or its assignee(s) to debit/charge the account noted above for the total due on that date for program tuition and fees.

I agree to make a reasonable attempt to resolve any dispute through communication with Cherry Preschool and not to dispute these scheduled transactions, so long as the transactions correspond to the terms indicated in this authorization form.

I acknowledge that debits/charges to my account will be scheduled for the first business day of the month or until such time as I notify Cherry Preschool in writing to discontinue this authorization.

I agree to generate receipts and view information about my account transactions on the MyProCare.com parent web portal.

I agree to pay to Warren W. Cherry Preschool any fees that are incurred from any return of my ACH/CCA payment for nonsufficient funds and that any continued non-sufficient funds situation may result in cancellation of my child’s program participation. Cherry Preschool, in its discretion, may terminate the customer’s ability to participate in the Automatic Payments process. Any termination will take effect only after all entries originated by Cherry Preschool have been honored.

I agree to notify Cherry Preschool in writing of any changes in my account information or termination of this authorization, within at least 5 business days prior to the next scheduled transaction date, so as to afford Cherry Preschool a reasonable opportunity to act on it.

I acknowledge that the origination of transactions to my account must comply with the provisions of U.S. law. I certify the information I have provided is true and that I am an authorized user of this account.

Signature(Required)