Gehringer Park Swim Team 2024 ACH Payment Plan Authorization
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Please list swimmers and ages as of June 15, 2024 (this will connect your payment to your swimmer's registration).
I would like to sign up for the Installment payment plan for my 2024 swim dues.
Yes
No
I (we) authorize Gehringer Park Swim Team to electronically debit my(our) account for installment payments for 2024. I (we) agree to automatic swim dues to be debited from my(our) account on the following dates: 2/15/24, 3/15/24, 4/15/24 and 5/15/24
Yes
No
Bank Routing Number
Bank Account Number
Account Type
Checking
Savings
Signature:
Submit
Submit
Should be Empty: