Automatic ACH Authorization

* Indicates required field

Student Name *

First

Last

I authorize Vibe Performing Arts, LLC to electronically debit my bank account on the first or each month according to the terms outlined below. I acknowledge that electronic debits against my account must comply with United States law.

Terms of Billing

Start Month/Year *

End Month/Year *

Recurring Amount *

Bank/Institution Name *

Routing Number *

Account Number *

Account Type *

Checking Savings

This payment authorization is to remain in effect until the end date or by notifying Vibe Performing Arts of its cancellation by giving written notice 30 days in advance for the business and receiving financial institution to have a reasonable opportunity to act on it.

E-Signarture Authorization *

I Authorize

Account Owner Name - E-Signature *

First

Last

Phone Number *

Email *

Submit