Misc - 2024 Online Payment Form

AUTHORIZATION AGREEMENT / DIRECT PAYMENTS ACH
Student Name*

First NameLast Name
I authorize LAKELAND BAND BOOSTERS (All Huron Valley Marching Band Payments are processed through the Lakeland Band Boosters account) to initiate either an electronic debit or to create and process a demand draft against my bank account according to the terms outlined below. I acknowledge that the origination of ACH transactions or charges to my credit card must comply with the provisioning of United States law.
Choose Your Payment Method
Please Select Only One:*

I prefer to pay via my financial institution (Bank or Credit Union) (no processing fee):I prefer to pay via credit card (4% processing fee will apply):
If Paying via Financial Institution (Bank or Credit Union), Please Complete the following:
Routing Number:
Account Number:
Please Select the Account Type:

CheckingSavingsConsumerBusiness
If Paying via Credit Card (4% Processing Fee Will Apply), You will be sent a separate bill from the treasurer to pay.
Choose Your Payment Plan:*

I would like to pay in full right now: $1350.00I would like to pay $250 non-refundable fee on 05/15/2023, and monthly payments of $275.00 on 06/15/2023, 7/15/2023, 8/15/2023 and 9/15/2023
Opt Out Options

Football Mania Fundraiser Opt Out: $50 (to be charged 09/15/2023)Volunteer Opt Out (General Hours/HVI/Winter Show Shifts): $200 (to be charged 04/15/2024)
Name*

First NameLast Name
Email*
example@example.com
Name on Financial Institution Account or Card Holder:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
If using a Credit Card to Pay, "I understand that there is a 4% Processing Fee that will apply to this transaction":*

YesDoes not apply to me, I am using my financial institution for payment.
Signature*

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AUTHORIZATION AGREEMENT / DIRECT PAYMENTS ACH

Choose Your Payment Method

If Paying via Financial Institution (Bank or Credit Union), Please Complete the following:

If Paying via Credit Card (4% Processing Fee Will Apply), You will be sent a separate bill from the treasurer to pay.