Fillable Printable Car Payment Agreement Form Sample

Car Payment Agreement Form Sample

Name Program | Session Cost 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

OCT NOV DEC JAN

FEB MAR APR MAY

Name Program Cost 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:_________________________