Tuition Express

Automated Payment Processing
Safe – Convenient – Easy

We are excited to offer the safety, convenience and ease of Tuition Express® – an automatic payment processing system that allows on-time tuition and fee payments to be made from your bank account

AUTHORIZATION FOR BANK ACCOUNT

I (we) hereby authorize Pettengill Academy to initiate debit entries to my (our) Checking or Savings Account indicated below. To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice.

Credit Union Members: Please contact your Credit Union to verify account and routing numbers for automatic payments.

Select Campus Location:(Required)

Your Name:(Required)

Phone #:(Required)

Email Address:(Required)

Address:(Required)

City:(Required)

State:(Required)

Zip:(Required)

Bank or Credit Union Name:(Required)

Bank or Credit Union Address:(Required)

City:(Required)

State:(Required)

Zip:(Required)

Routing Number:(Required)

Account Number:(Required)

Account Type:(Required)

Checking

Savings

Signature:(Required)

Today's Date:(Required)

For Official Use Only...

Date Received

Employee Signature

Tuition Express

Tuition Express

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