Campus After School Program Checking/Savings Authorization

Campus After School Program

2901 Campus Rd. Brooklyn, N.Y. 11210 (718) 421-7575

CHECKING/SAVINGS WRITTEN AUTHORIZATION FORM

I (we) hereby authorize Campus ASP Inc. to initiate entries to my (our) checking/savings accounts at the financial institution listed below (THE FINANCIAL INSTITUTION), and, if necessary, initiate adjustments for any transactions credited/debited in error. A $30 charge will occur if your payment is denied by your bank.
Address of Financial Institution *
Address of Financial Institution
City
State/Province
Zip/Postal
Country
Account Type *
The recurring Debit will take effect on or after September 1, 2020 and will be processed on the 1st of every month until June 2021 in the:
$
Consumer Address *
Consumer Address
City
State/Province
Zip/Postal
Country
If you should need to notify us of your intent to cancel and/or revoke this authorization you must contact us 1 week prior to the questioned debit being initiated. Please call 718-421-7575 or email at info@campusasp.com Monday-Friday from 10:00am to 6:00pm.