Preschool Tuition Express Enrollment Form

Paperwork for *enrolled* families

Preschool Tuition Express Enrollment Form

Enroll in Preschool AutoPay

Electronic Funds Transfer Authorization for Bank Account
I (we) hereby authorize DODGE NATURE PRESCHOOL to initiate debit entries to my (our) checking account indicated below. To properly affect the cancellation of this agreement, I (we) are required to give at least 10 days written notice.

Enrolled Student Name(s)(Required)

First Last

Name(s) on Account(Required)

First Last

Your Phone Number(Required)

Your Address(Required)

Street Address City State ZIP Code

Bank or Credit Union Name

Bank or Credit Union Address(Required)

Street Address Address Line 2 City State ZIP Code

Bank or Credit Union Routing Number(Required)

The routing number is the first set of numbers printed on a check or deposit slip. (for example, 019000019)
*IT IS VERY IMPORTANT TO DOUBLE CHECK THIS NUMBER.*

Re-Enter Routing Number(Required)

Checking Account Number(Required)

*IT IS VERY IMPORTANT TO DOUBLE CHECK THIS NUMBER.*

Re-Enter Checking Account Number(Required)

Signature(Required)

Today's Date

Email address for confirmation(Required)

Please note: We will not send your bank information in the confirmation email.

Enter Email Confirm Email

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Preschool Tuition Express Enrollment Form