Billing Information Form

Bank Account Information

Name on Account

ABA Routing Number

Account Number

Bank Account Type (Only For Bank Account)

Checking
Savings
Business Checking

Bank Name

Credit Card Information

Name on Card

Credit Card Number

Expiration Date

Customer Billing Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

I _____________, the parent of _______________ authorize for Day Care to enroll me in automatic payment.

Signature

Note: We will charge the account on every Tuesday

Email

Interested in good preschool education for your child? Our Daycare Center is the right decision!

HOW TO ENROLL YOUR CHILD TO A CLASS?

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