Child Registration Application Page 4

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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 __________________

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Parent category: Business