ACH Payment (Savannah)

The Kid’s Corral
631 Magnolia Blvd.
Savannah TX 76227

ACH / Electronic Check Authorization

By signing this agreement, I hereby authorize The Kid’s Corral to electronically debit the checking or savings account indicated below for payment authorized under this agreement and due in accordance with the Kid’s Corral Agreement. I understand that the effective date of these electronic debits to my account will be made on the day of the week I specify below and in the frequency I also specify below. I understand that if the debit is returned unpaid due to insufficient funds, I may be charged a $30.00 NSF Penalty or the returned item in addition to any charge my banking institution may levy. In authorizing this payment, I have read and understa
nd the terms and conditions of this agreement.

Account Holder’s Name:

Address:

Phone Number:

Email Address:

Child’s Name(s):

Name of Bank:

Bank Routing Number (Must be 9 Digits):

Bank Account Number:

Payment Amount:

ONE TIME PAYMENT: $

Re curring Start Date :

Recurring Frequency

Weekly

Every 2 Weeks

Every 4 Weeks

If you should need to notify us of your intent to refund a payment, please contact us up to 14 business days after the questioned debit. Please call (
972) 346-2100 or email us at
brenda@thekidscorral.com from 9A to 5P during regular business days (excluding Holidays or Saturday or Sunday)

I hereby assert that I am either the rightful and legal owner of the above account or I am a duly authorized signer on the account with the power to authorize these transactions

Print Name

Signature

Date