Kirkland Autopay – AL Art Studio

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Student's Name (Siblings may Enter the first name together)

First

Last

Art Classes Location

First & Last Name on Card

Tuition and Duration ($5 Discount Applied)

Email for the payment receipts

Supplies Rental options

Relationship with the student(s)

which month you wish to start the autopay?

name below Last

Card Number (Visa/Mastercard only)

Exp. Mon/Yr

Billing Zipcode

Please read and check all of the boxes below

I authorize a $10 charge for activation of autopay, till I cancel it. I understand the autopay can be paused any month at on-holding fee $5 each month.
I authorize regularly scheduled charges to my credit card on the 20 th of each month, I’ll be charged the amount indicated below each billing period. I agree that no prior-notification will be provided unless the date or the amount changes.
In case I would need to discontinue the monthly class, I’ll notify AL Studio by e-mail or in writing at least 2 business days prior to the billing date (20th every month). If the transaction already occurs, we may use it for the following 3 months' tuition when returning. For tuition refund requests, there is a $10 credit transaction fee
I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form.
I understand that all credit card payment information will be processed by TrustWave using safe and secure encryption. AL Studio will not share any end user identifiable data or payment instrument data with any third-party vendors.