RnD Academy Payment Change Request Form / 30 Day Drop Contract

RnD Academy

30 Day Drop Notice Contract/ Credit Card Cancelation Form
Please choose your form type:*

30 Day Drop NoticeCredit Card Cancelation Form for Auto-Pay
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
To:RnD Academy

2500 E Imperial Hwy #149A-322

Brea, Ca 92821 admin@mdacademy.com

RE:Cancellation of authorization for debits or 30 Drop Notice

To RnD Academy,

Please cancel my automatic payments from my Credit Card account for payments at my child's school for RnD Academy. I am writing to inform you that I am canceling authorization for you to debit my Credit Card account via Virtual Orbit and Square:

I understand the cancellation applies 30 days from this notification and that I am responsible for all charges within the 30-day notice and any classes given in advance.

I understand this cancellation notice will be date-stapmed with today's date to mark the start of my 30 day notice.
Please check all that apply:*

This Automatic Payment Cancelation does not drop my student from the RnD Academy Program, only the payment method. I will continue paying monthly for classes via an alternative method. Please list alternative payment method in the selection for OTHER: Square, Venmo, Zelle, Check or Apple Pay.This cancellation is my 30-day Drop Notification for my student from the RnD Academy Program. My child's last day with RnD Academy is 30 days from today's date and I understand I will be charged for 30 additional days as well as all make-up classes or extra classes my child received in advance.Other
Child's Name*
Child's School*
*Please note that the date of the cancellation notice needs to match the date emailed. Otherwise, the date of your email submission will determine the final cancellation date.
This cancellation is for card ending in: Last 4 #'s of Card On File:*
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RnD Academy Office Use Only: Final Tuition Due & Charge Date:
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