AutomaticPayment2011-2012 by suchenfz

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									                                  Now Available
                     Preschool Automatic Scheduled Payments!

       We would like to extend to you the convenience of automatic payments for your
       child’s preschool monthly payments.
       If you are interested in automatic payments, please complete the “Childcare
       Scheduled Payment Contract” and return it to the Shephard Center, 421 N.
       Springinsguth Road, Schaumburg, IL 60194.
       A $10.00 convenience fee, per family, will be debited from the credit card you
       specify on the “Childcare Scheduled Payment Contract”. If you currently pay
       2010-2011 preschool payments by automatic scheduled payment, this fee will be
       waived. A new form must be completed each school year.
       The September 2011 payment will be automatically debited on September 1st
       from the credit card you specify on the “Childcare Scheduled Payment Contract”.
       You will still receive a monthly invoice for your records.
       Feel free to contact the Shephard Center at 847-490-7036 with any questions
       you may have regarding this convenience.
       Sincerely,
       Schaumburg Park District Preschool

                                                  Childcare Scheduled
                                                  Payment Contract
Today’s Date                                           Program(s)
Main Contact Name                                                          Home Phone #

Child’s Name                                                               Course Barcode #
Child’s Name                                                               Course Barcode #
Child’s Name                                                               Course Barcode #


I,                                         , give authorization to the Schaumburg Park District to debit my
Visa / Master Card / Discover Card / American Express the total amount of       $ Per Invoice    on a monthly basis from
September 2011 to         April 2012    . These debits will occur on the       1st    day of each month. I also agree to
be charged a $10.00 convenience fee per family, due upon receipt of this contract for this childcare year.

      Visa                      Master Card                         Discover Card                      American Express
Card Number:                                                                              Exp. Date:
Name as it appears on the card (Please Print):
Cardholder Signature:                                                                                  Date

								
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