Kumon Manlius EFT Registration

Kumon of Manlius - EFT Registration
If you prefer to download and print the form, CLICK HERE TO DOWNLOAD THE EFT FORM. Print the form and bring to the Kumon Center, along with a voided check.
Parent/Guardian Information
Parent / Guardian Name*

First NameLast Name
E-mail*
example@example.com
Cell Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Information
Student's Name*

First NameLast Name
Number of Subjects*

1 Student / 1 Subject1 Student / 2 Subjects
2nd Student's Name (If Applicable)
Number of Subjects

1 Student / 1 Subject1 Student / 2 Subjects
Price List Payment Option*

Monthly / $160 Per Subject3 Months / $465 ($155 per month)6 Months / $900 ($150 per month)Annual / $1740 ($145 per month)
Comments or Notes (Optional)
Banking Details

You can provide your banking details below or in person at the Kumon Manlius Center.
Bank Name*
Bank Account Number*
Bank Routing Number *
Account Type

CheckingSavings
Should be Empty:

Kumon of Manlius - EFT Registration