Checking Account Debit Authorization - Howell Academy of Dance Dance Classes Howell NJ, Dance Lessons Monmouth County NJ

Fields that have an * are required.

This form allows Howell Academy to have your child's tuition taken out of your checking account monthly from Sept. 2022 to May 2023
You must upload a photo of a Voided Check at the end of this form.
Name*
First Last
Address*
Street Address City State ZIP Code
Checking Account Information
Please debit payments from my checking account, below.
Routing Number*

Valid Routing # must start with 0, 1, 2, or 3
Account Number*
Consent - authorization*
I authorize Howell Academy of Dance and Vanco Services, LLC to process debit entries to my account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the authorization.
Consent - same checking account
I authorize Howell Academy of Dance & Vanco Services to continue using the same checking account that is already on file from the previous school year.
Consent - late fee*
I understand that Howell Academy of Dance will debit my checking account for any outstanding costume balances not paid by the due date with a $10 late fee.
Upload a photo of a VOIDED check.*
Max. file size: 50 MB.
Your Name - As Your Digital Signature*

This form allows Howell Academy to have your child's tuition taken out of your checking account monthly from Sept. 2022 to May 2023