Authorization Form for Monthly Automatic Tuition Payments

We are thrilled that you have chosen Noah’ Ark Preschool for your child. We are looking forward to getting to know you. At the time of registration the $55 registration fee and your May 2009 tuition payment is due. You will have 8 additional tuition payments. They are due on the first of each month, September through April. 

Through Thrivent Financial, we are able to receive your tuition payment automatically through a program called Simply Giving. The Simply Giving program provides an easy, no-cost way for the preschool to collect tuition and allows us to benefit from consistent cash flow. Tuition payments are made to Noah’s Ark through a pre-authorized withdrawal from your bank account and deposited into our bank account on the same day it is withdrawn from your account. Your first payment is deducted on September 1, 2008 and your last payment on April 1, 2009.

Instructions:

1. Complete the personal information section below, including name, address and telephone numbers.

2. Indicate the account type, routing number and account number. 

3. Sign on the Account Holder Name line.

Please complete this section for school tuition payments:

Child's Name

,  ,
Last Name:                     First Name:                   Middle Initial:

  
Mailing Address                                           ZipCode

Home Telephone xxx-xxx-xxxx
Work Telephone xxx-xxx-xxxx
Cell Telephone xxx-xxx-xxxx

Check the appropriate box:
Payments should be taken from:      checking          savings

Use the following graphic as a guide	Name of bank; i.e. USBank   Location of bank; i.e. Circle Pines
	Routing number (9 digits)  # must start with 0, 1, 2 or 3 Bank Account Number

Please double check your Routing number and Bank account entries

I authorize Noah’ Ark Preschool (through Thrivent Financial and Vanco Services) to automatically withdraw my child’s tuition payments from my account from September 1, 2007 through April 1, 2008.

Account Holder’s Name:                Datexx/yy/zzzz

complete authorization for automatic tuition payments

Return to Home Page

 
Noah’s Ark Preschool ~ 9185 Lexington Avenue North ~ Circle Pines, MN 55014 ~ 763-784-5928