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Payment Method Form

Parent or Legal Guardian Name:

Student Name (1):

Student Name (2):

Payments

East Valley School of Music requires tuition payments to be collected automatically on the 25th of each month. Invoices will be emailed on the 18th of each month for customer records.

Please choose from one of the following payment methods:

(Once recorded, this form will be shredded for security)

Bank Account

Customer provides a bank account and routing number.

Save $15 instantly off the first tuition payment by using this method

*Must continue with this payment method for a period of at least 6 months or the $15 discount is forfeit.

Bank Name:

Name on Account:

Routing # (9 digits):

Account #:

Account Type: CheckingSavings

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 $20 late fee will be assessed.

Name on Card:

Card Number:

Expiration Date:

VisaMastercardAmerican ExpressDiscover

Card/Account Billing Address:

Leave this empty:

Your legal name

Your email address