East Valley School of Music

Payment Method Form

Parent or Legal Guardian Name:  

Student Name (1):   

Student Name (2):  


East Valley School of Music requires tuition payments to be collected automatically on the 20th of each month. 

Please choose from one of the following payment methods:

Bank Account

Customer provides a bank account and routing number.

Save $20 instantly off the first tuition payment by using this method

*Discount applicable for private lessons only, not for group classes. Must continue with this payment method for a period of at least 6 months or the $20 discount is forfeit.

Bank Name:  

Name on Account:   

Routing # (9 digits):  

Account #:  

Account Type:


                                      Sample from bottom of check


Credit/Debit Card

Customer maintains current credit or debit card information on file. If a card is declined or expired, East Valley School of Music will contact customer. If payment issues are not resolved by the end of the month, a $25 late fee will be assessed.

Name on Card:   

Card Number:  

Expiration Date:   


Card/Account Billing Address:



Leave this empty:

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Document name: Payment Method Form
lock iconUnique Document ID: e10ee02b262c526cb54f0ff404e642e13f0c3b66
Timestamp Audit
June 29, 2022 3:12 am MSTPayment Method Form Uploaded by Mike Kaminski - office@evsm.net IP