Gehringer Park Swim Team 2026 ACH Payment Plan Authorization
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please list your swimmers and their ages as of June 15, 2026 (this will connect your payment to your swimmer's registration):
I would like to sign up for the installment plan for my 2026 swim dues:
Yes
No
I (we) authorize Gehringer Park Swim Team to electronically debit my (our) account for installment payments for 2026. I (we) agree to automatic swim dues to be debited from my(our) account on the following dates: 2/15/26, 3/15/26, 4/15/26 and 5/15/26.
Yes
No
Bank Routing Number
Bank Account Number
Account Type
Signature
Continue
Should be Empty: