Meadow Montessori School, Metro Vancouver, Maple Ridge BC, Preschool, Kindergarten to Grade 7
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Media Authorization Form – Updated 2023
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Authorization for Pre-Authorized Debit
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Authorization for Pre-Authorized Debit
This form is used to authorize a set amount to debit from an account.
Parent/Guardian Name
(Required)
First
Last
Student Name
(Required)
First
Last
Date
(Required)
MM slash DD slash YYYY
Preauthorized debit
(Required)
Please take the following amount from my account.
Amount of payment:
(Required)
What is this money for?
(Required)
Signature
(Required)
I confirm the school has my pre-authorized debit information (banking information) and I authorize the school to debit the amount as indicated above within one month of receipt of this authorization.
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