PAYMENT PLAN AUTHORIZATION FORM 2017/2018

Payment Plan Type *
-Single Payment – Due Aug 15 -Two (2) Payment Plan – ½ due Aug 15; balance due Dec 15 – 1/10 due each month from Aug 15 thru May 15. There will be a $5 charge for each payment to over administrative costs. Please note that your monthly installment may change due to additional charges or adjustments on your account.
**All members on payments plans will receive an email reminder. Credit cards will automatically be charged by Temple Beth Rishon if a check or cash are not received by the due date. Credit card statements and cancelled checks will serve as receipts.
Part 2 - Credit Card Authorization (Required for all Credit Card and Extended Payment Options)Section 2
I/We elect to pay by: *
By checking below I authorize my signature. *