E-Check payment

One Time E-Check ACH Authorization

* Indicates required field

Student Name *

First

Last

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

Terms of Payment

Date *

Amount *

Payment Description *

Bank/Institution Name *

Routing Number *

Account Number *

Account Type *

Checking Savings

E-Signature Authorization *

I Authorize

Account Owner Name - E-Signature *

First

Last

Phone Number *

Email *

Submit