A's Fall 2024 (10th, 11th, 12th) Pay in Full EFT Form

1
Player's Name* This field is required.
First Name
Last Name
2
Player's Grade* This field is required.
Please Select
Please Select
12th
11th
10th
3
Parent Email* This field is required.
example@example.com
Confirm Email
4
Player Fees & Payment Plans Agreement
5
I, Agree to & provide my Authorization to the A's Player Fees & Payment Plans Agreement* This field is required.
I Agree
6
Authorization Person's Name* This field is required.The Name of the Person Paying
First Name
Last Name
7
Authorization Person's Signature* This field is required. I, AUTHORIZE MY BANK TO MAKE PAYMENTS BY THE METHOD INDICATED ABOVE, INCLUDING DIRECT BILLING FEES AND UNIFORM FEES. I ALSO UNDERSTAND PAYMENT WILL BE PULLED UNTIL PAYMENT FOR THE MONTH IS CLEARED OR BALANCE FOR THE SPRING/SUMMER/FALL SEASON IS CLEARED. I UNDERSTAND AND AGREE THAT I HAVE SIGNED A CONTRACT AND I AM BOUND BY ALL RULES AND REGULATIONS OF ARLINGTON A’s.
8
Payment Plan Selection* This field is required.
Please Select
Please Select
Pay in Full
9
Pay in Full* This field is required.
prevnext( X )
795.00
USD
Description
USD
+ OR enter a custom value
eCheck.Net A's EFT Draft
Checking
Savings
Bank Account Type
Routing Number
Account Number
Name On Account
Bank Name
Should be Empty: