Rain City Fencing Center
Authorization for Automatic Credit Card Payment

Student’s name: __________________________________________________________

Parent’s name (if applicable): _______________________________________________

Contact phone number: ____________________________________________________

VISA/MasterCard number: _________________________________________________

Expiration date: ________      ZIP code for credit card billing address: _______________

Name on the credit card: ___________________________________________________

Authorized signature: ______________________________________________________

(Credit card must be presented in person at least once before automatic billing can start.)

Please bill me automatically for the following services:

___ Regular class fee ($120 / month, $110 / month for multiple students)

___ Monthly floor fee for open fencing ($75 / month)

___ Lesson card: ___ lessons each month at $___ each

___ Equipment purchases

Rain City Fencing Center will bill the above credit card account for the services indicated. Class fees will be billed one week before each monthly session starts. Monthly floor fees, lessons, and equipment purchases will be billed the first of each month. Rain City Fencing Center must receive notification of any changes in enrollment or payment choices at least one week before the billing date. Rain City Fencing Center reserves the right to terminate this service at any time.

I agree to the above terms and conditions.

________________________________________________  Date: __________________
(Signed)