ACH Form

ACH Form

Name *

First

Last

Childs Name *

First

Last

Checkboxes *

• Checking Account
• Business Checking
• Savings Account

Bank Name *

Routing Number *

Account Number *

Checkboxes *

• are you at Pearland
• are you at Dickinson

Address *

City *

Zip Code *

Phone # *

Email *

I hereby authorize my bank to debit my account as identified above to the terms as stated in the 'Lesson Contract'. This authorization should remain in effect for the remainder of the contract. I hereby agree to give Hardball Academy (15) days notice prior to renewal of contract. If notice is not given, contract will automatically renew at the first of each month. *

• I Agree

Declined ACH payments will need to be converted to a CC payment after the 1st declined charge. Declined payments are automatically charged a $25.00 fee. *

• I Agree

Notice to terminate contract must be given the 1st through the 15th of the month before contract renews or contract will automatically renew (Notice must be sent to info@hardballacademy.com) *

• I Agree

Signature *

Name

Submit