24-25 Tuition ACH Authorization

DIRECT PAYMENT VIA ACH AUTHORIZATION
I authorize "Unity Christian High School" hereinafter called "Company," to initiate debit entries to my account indicated below and the Financial Institution name below, hereinafter called "Financial Institution," to debit the same account. I acknowledge that the origination of ACH transactions to my account must comply with U.S. law.
Name

First NameLast Name
Financial Institution Name
City
State
Zip
Bank Routing Number
Account Number
Type of Account:

SavingsChecking
Fixed Payment Dollar Amount
Amount to withdrawal from your account each month:
Date of Payment:

1st of the Month (starting September 1st)20th of the Month (starting September 20th)1st & 20th (amount above split 50/50)
ACH payments will not be established until September and will run through June 2025 unless otherwise noted below. This will be a total of 10 payments.
Please upload a picture of a deposit slip or voided check for proof of account ownership. If you participated in prior years you do not need to submit a new one, unless the account has changed.

This authorization is to remain in full force and effect until Company has received written notification from me (or any authorized account signer) of its termination in such time and manner as to afford the Company a reasonable opportunity to act on the request. Unless prior authorization to terminate this request is made, the Company will terminate the request on 7/31/2025.
Picture of voided check or deposit slip:

Cancelof
Print Individual Name
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

DIRECT PAYMENT VIA ACH AUTHORIZATION