Auto Payment Enrollment Form

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Park City Rotary's Auto Payment plan is an optional, convenient program that automates your monthly invoice payments. You can pay using any major credit card, or by e-check using your bank account.

**All Rotarians will always receive their monthly invoice via email. If you enroll in Auto Payment, your invoice will be paid automatically and you'll receive an emailed receipt. If you do not enroll, you will make payment using your traditional method. The choice is yours.**

Is this a new enrollment or change of payment method? *

New enrollment

Change of payment method

Rotarian Name *

Email Address *

Choose your payment method: *

Credit/Debit Card (Visa, MC, Discover, AMEX)

E-Check (direct debit from bank account)

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