St. Mary's Academy & College
 

Direct Payment via ACH Authorization

I authorize St. Mary’s Academy & College to initiate debit entries to my account (indicated below) and the Financial Institution named below to debit the same account. I acknowledge that the origination of ACH transactions to my account must comply with U.S. law.

Account Details

Type of Account *

Payment Details

  • Fixed monthly payments indicated below will be drafted on the 10th of each month (starting the month following submission of this form)
  • Fixed weekly payments indicated below will be drafted each Monday (starting with the second Monday following submission of this form)
  • Any one-time payment indicated below will be drafted on the second Monday following submission of this form
Please choose one or more items for which you wish to set up payments.
You will be prompted for payment amount and frequency.
Payment Frequency *
Payment Frequency *

     Note: Will be drafted on the first banking day following each of the six Holy Days.

Payment Frequency *
Payment Frequency *
Payment Frequency *
Payment Frequency *
Payment Frequency *
Payment Frequency *
Payment Frequency *
 
Payment Frequency *

Contact Information

Authorization

This authorization is to remain in full force and effect until St. Mary’s Academy & College has received written notification from me (or any authorized account signer) of its termination in such time and manner as to afford a reasonable opportunity to act on the request.
Signature *
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