EFT EFT Release Form Student's First Name* Student's Last Name* Date MM slash DD slash YYYY Monthly Tuition Amount* Routing Number - Checking Account (9 Numbers Required)* Account Number - Checking Account* Account Holder's Name* Phone*Email* I understand and accept the following conditions: (please read and initial each line)* Select All Elite Dance Studio has permission to deduct monthly tuition fees from my specified account. Deduction will begin on the month the completed form was received and continue on the 10th of each month through June 2024. Elite Dance Studio will not deduct costume fees, ticket fees or registration fees. Those fees must be paid by check or cash directly to studio. I understand that a $30.00 NSF will be charged if adequate funds are not available. If this happens, you will be contacted by email. Elite Dance Studio will not make a second attempt via EFT to collect funds. Account must be made current by paying with check or cash and will include the $30.00 Fee. I understand that I must contact Elite Dance Studio in writing if I need to change accounts or if I would like to discontinue with “EFT”. This must be done by the 1st of the month for any changes to go into affect that calendar month. Failure to do so may result in a $30.00 fee. Adult (over 18) signing student release (typing of name constituted a signed waiver)* First Last Signature*Remarks / CommentsCompleted form must be received by the 5th in order for EFT to begin in that calendar month. Once you have completed your EFT form your monthly statement will read “Thank you for your EFT payment”. These statements are just for your records, you do not need to submit further payment. Any questions, please email Elite’s Office Manager Phyllis, at info@elitedancestudio.org NameThis field is for validation purposes and should be left unchanged. Δ
