Fillable Printable Car Payment Agreement Form Sample
Fillable Printable Car Payment Agreement Form Sample
Car Payment Agreement Form Sample
Name Program | SessionCost Deposit Balance
SESSION 1: AP GROUP 1: Season Courts & all Session 1 programs. AP Group 2: High School Clinics
SESSION 2: AUTOPAY GROUP 1: All Session 2 programs
OCTNOVDECJAN
FEBMARAPRMAY
Name ProgramCost Deposit Balance
MONTHLY PAYMENTS / OFFICE USE ONLY
Milford Indoor Tennis -580 Bridgeport Ave - Milford, CT 06460
AUTO PAYMENT AGREEMENT 2013—2014
Auto Pay Agreement
Balance will be paid in monthly installments automatically deducted
without interest from credit card listed below. I authorize Milford Indoor
Tennis to automatically charge my VISA, MasterCard, American Express
or Discover for the monthly amounts listed below due under this
payment plan. Season Courts and all Session 1 programs are paid in four
equal installments beginning in October. Session 2 programs are paid in
four installments beginning in February. The 1 session High School
program will be paid in six equal installments beginning in October.
Date:___________________________________________
Signature:_______________________________________
Family Name: ________________________________________
Member Number (Phone #): ____________________________
Credit Card Information:
C/C #_______________________________________________
EXP: _______________________________________________
TYPE: ( VISA MASTERCARD AMEX DISCOVER )
Cardholder acknowledges receipt of goods and / or services in the amount of the total
shown hereon and agrees to perform the obligations set forth in the cardholders
agreement with the issuer.
Email:_______________________________________________
Failed payment policy
If your credit card declines during any month, we attempt to
reprocess it. If a second attempt also declines, you will be
responsible for the entire balance to be paid in full.
Set-up Fee: $25 per season. (ONE-TIME & NON-REFUNDABLE)
(September 5, 2013 — June 1, 2014)
DATE PAID:_________________________
