Crossroads Daycare Tuition Payments Form

We are excited to offer the safety, convenience and ease of automated payment processing that allows secure, on-time tuition and fee payments to be made from either your bank account or credit card.

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT

I (we) hereby authorize Crossroads Daycare to initiate debit entries to my (our) checking or savings account, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. Credit union members: please contact your credit union to verify account and routing numbers for automatic payments. Check with the center for accepted credit card types.
Payment Type *
Today's Date Today's Date / MM / DD YYYY
BANK ACCOUNT

You must complete all Fields in this section if using a bank account for payments.
Your Name
Phone Phone - ### - ### ####
Your Address Your Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Bank or Credit Union Name
Bank or Credit Union Address Bank or Credit Union Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
See Check for Placement of Numbers
Account Type

Account Type Checking Savings
Routing Transit Number (see sample above)
Account Number (see sample above)
Please upload a picture of a voided check

Attach Files

If you are having an issue with a mobile upload, save the file first to your camera roll before attempting to upload to our servers.
Today's Date Today's Date / MM / DD YYYY
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Crossroads Daycare Tuition Payments Form

Crossroads Daycare Tuition Payments Form

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT

BANK ACCOUNT

See Check for Placement of Numbers