2015-2016 Autopay Agreement

Name *
Agreement between: ______________________ (Client) and Eclectic Music for weekly music lessons.
Contract Start Date: 8/1/2015 or client's first lesson, whichever comes last.
Contract End Date: 5/1/2016
Contract Duration and Automatic Renewal *
Agreement to Pay Recurring Fees *
Amount shown is per payment (nine payments total plus a tenth for the optional summer session).
The traditional plan includes four lessons per payment.
The floating plan includes three lessons per payment. Lessons occur during off-peak hours (before 3 PM or after 7 PM on weekdays throughout the school year and on Saturdays and Sundays, subject to availability).
Authorization *
Payment dates are as follows:
August 1
September 1
October 1
November 1
December 1
January 1
February 1
March 1
April 1
Authorized Card Holder *
Late Fees and Failed Authorization *
Deactivation *
Freezing Autopay *
Date *