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
2011 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 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through a pre-authorized withdrawal from your bank account and deposited into our bank account on the same day it is withdrawn from your account.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,
2010 and your last payment on April 1, 2011.
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:
Use
the following graphic as a guide
Name
of bank; i.e. USBank
Location
of bank; i.e. Circle Pines
Routing number (9 digits) Re-enter
Routing number # must start with 0, 1, 2 or
3
Bank
Account Number
Re-enter Account Number
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, 2009 through April
1, 2010.
Account Holder’s
Name:
Datexx/yy/zzzz
complete authorization for automatic tuition payments
Or,
Use your credit card or PayPal to pay your tuition and/or
Registration Fee
Or,
Pay with your checks
Noah’s Ark Preschool ~ 9185 Lexington Avenue North ~ Circle Pines, MN 55014 ~ 763-784-5928
