Meadow Montessori School, Metro Vancouver, Maple Ridge BC, Preschool, Kindergarten to Grade 7

Authorization for Pre-Authorized Debit

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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)

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.