AUTHORIZATION FORM

Child's Full Name*
Your Full Name*
Your Email*
Enter Email Confirm Email
Payment Options
By completing the form below, Piper Preschool has my continued authorization for charges associated with the contracted school year. I understand that any credit card payment will incur a 3% convenience fee.
Payment Type
- Bank Account
- Credit Card
Bank Name*
Account Holder's Name*
Account Holder's Phone*
Bank Routing Number*
Bank Account Number*
Account Type*
- Checkings
- Savings
Name on Credit Card*
Credit Card Number*
CVV*
Expiration Date
Phone Number Associated with Card*
Billing Address*
Street Address Address Line 2 City State ZIP Code

Payment Options