Auto Draft Modification/Cancellation Request Form
This form is used to request modifications or cancellations of automatic payments via Tuition Express. Requests must be submitted at least 10 days prior to the desired effective date.
Which Creche location does your child attend?
*
Please Select
The Cradle @ Creche
Creche- Grand Mere
Creche @ Heritage Square
Parent/Guardian/Payer Name:
*
First Name
Last Name
Your Contact Email:
*
example@example.com
What would you like to do?
*
Cancel Existing Autopay
Modify Autopay type
Reason for Modification/Cancellation:
*
Requested Effective Date for Auto Draft Modification or Cancellation:
*
-
Month
-
Day
Year
Date
How will you be making payments moving forward?
*
Add new ACH or Credit Card information for autopay
Manual Credit Card payments at the kiosk
Payments via the ProCare app
Other
I understand that autopay modifications and cancellations require 10 days’ notice to complete. If I choose a date that is fewer than 10 days from today, I acknowledge that the effective cancellation date may be adjusted to meet this notice requirement.
*
Please Select
I agree.
Signature
*
Continue
Continue
Should be Empty: