BrainHub Learning Centre Debit/Credit Card Authorization Form
Please complete the form below for BrainHub to process your installment payments.
Email address *
Card Number *
Cardholder's Name *
Expiration Date (mm/yy) *
CVV (digits on the back of card) *
Billing Address *
Please select your child's class(es): *
Required
I authorize BrainHub Learning Centre to process this card for the agreed services based on the payment schedule provided. *
A copy of your responses will be emailed to the address you provided.
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