ACH Authorization

AUTHORIZATION AGREEMENT FOR PRE-AUTHORIZED PAYMENTS For 2018/2019 School Year
* Denotes Required Fields
IF YOU CANNOT COMPLETE ALL REQUIRED FIELDS CONTACT THE ADMINISTRATIVE OFFICE AT 518-477-4125

*The ABA Number is the first nine digits listed on the bottom of your check.
check

* One Account Holder Name Is Required

Please deduct the following dollar amount from my account monthly (between the 20th – 25th day of each month beginning,

/20/

This authority is to remain in full force and effect until Greenbush Child Caring, Inc. and Depository have received written notification from me (or either one of us) of its termination in such time and in such manner as to afford Greenbush Child Caring, Inc. and Depository a reasonable opportunity to act on it.

If there are two names on the account, both account holder signatures are required

By signing and electronically submitting this ACH form you are agreeing to monthly tuition payments being deducted and any additional amounts if you make a change to enrollment, have late payment, late pick-up fees or choose to add additional (single, full or half) days.

Greenbush Child Caring Inc. Info

Greenbush Child Caring, Inc.
620 Columbia Turnpike
East Greenbush, NY 12061

Phone (518) 477-4125
Fax (518) 479-4240
E-mail contactus@gbccinc.org

Copyright © 2018 Greenbush Child Caring, Inc. | Privacy Page