Child Registration Application (Page 4 of 13) in pdf

Child Registration Application Page 4

CUSTOMER CREDIT CARD AUTHORIZATION FORM

This information is confidential. This form will only be kept by Sunny Skies Preschool Finance Department

PARENTS NAME: __________________________CHILD’S NAME: ________________________________

ADDRESS _______________________ CITY _________________ STATE__________ ZIP______________

PHONE NUMBER ________________________________________

NAME AS APPEARS ON CREDIT CARD _____________________________________________________

CARD TYPE Visa

MasterCard

American Express

CREDIT CARD NUMBER ______________________________ EXPIRATION DATE__________________

THREE DIGIT CODE _____________

FOUR DIGIT AMERICAN EXPRESS: _____________________

AUTHORIZATION SIGNATURE ______________ ______________________ DATE __________________

*This credit card authorization form MUST be filled out if you submit cash payments OR voucher payments.

*By signing this form, the signee authorizes Sunny Skies to charge that credit card account in the event payment is not

made on time or a check bounces, no notice will be given in advance prior to charging the card and in the event the

card gets declined your child will not be allowed back into the school until all payments have been satisfied. All

PayPal fees will be added to the amount (6% of total transaction).

It is the sole responsibility of the cardholder to provide proper and accurate information and to update all accounts on

record.

AUTHORIZATION SIGNATURE ____________________________________ DATE __________________

Child Registration Application Page 4