FHC Credit Card Authorization Form

Credit Card Authorization Form

This authorization form will be used by OASN and/or Faith Holistic Academy to charge your credit card for monthly tuition, late pick up fees, etc.

This is required prior to enrollment.or whenever you need to change the credit card on file).

By signing this form you understand that your information will be saved on file (in the ecommerce portal) for future transactions on your account.

This authorization will remain in effect until cancelled or changed. If you cancel prior to balances being paid you will be required to pay cash, at our discretion.

Special Note:In the event that you do not authorize your quarterly scholarship payment to OASN &/or Faith Holistic Academy and/or your funding does not get deposited into your SUFS account for OASN to request payment, your full tuition payment could become due to OASN and/or Faith Holistic Academy. Should the amount that we have estimated for you to pay monthly need to be adjusted due to actual quarterly payment made by your Tax Credit Empowerment or your Unique Abilities Empowerment Scholarship, our finance department will let you know and begin the new monthly auto pay amount at the next auto pay date as per your schedule with us. Please contact us with any questions.

Student's Name (if more than one student, list the other names in the comment section below)

First NameLast Name

Other Student Names or Information we should know.

Name of Parent/Guardian

First NameLast Name

Email

example@example.com

My Products

Credit Card Authorization$1.00

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Sign to approve this credit card authorization for Faith Holistic Academy and or OASN.

Sign here and press the red submit button to complete your authorization