Automatic Payment Form (Credit Card or Debit Card) Please enable JavaScript in your browser to complete this form.Name On Card *FirstLastChilds Name *FirstLastWhich coach are you with? *Checkboxes *are you at Dickinsonare you at PearlandCredit Card information *Updating Credit Card/Debit CardNew Credit Card /Debt CardUpdating addressAddress *City *State *Zip Code *Phone # *Email *Card Number *Expiration Date *Security Code *Signature *Date *Notice to terminate lessons must be given (15) days prior to contract renewal or contract will automatically renew (Notice must be sent to info@hardballacademy.com) *I AgreeI am authorizing my card to be charged for services and for any balances that are due *I AgreeFor all credit/debit card transactions there is an automatic 3% processing fee *I AgreeNameSubmit
