ACH Authorization
Fill in the following form to authorize Bay Language Academy to automatically take monthly payments from your checking, savings, or business checking account. Payments will be taken on or around the 1st of each month for payments due that month.

You can revoke this authorization at any time by sending an email to, or in writing to
Bay Language Academy - Billing Dept.
1325 High Street
Alameda, CA 94501
Name on Bank Account *
Your answer
Phone Number *
Your personal phone number (usually your home phone number) associated with the bank account
Your answer
Bank Name *
Your answer
Bank Account Type *
Bank Routing Number *
This is a 9-digit number located on the bottom of your check. It is also know as the ABA number.
Your answer
Bank Account Number *
This identifies your individual bank account to the check and is usally an 8-12 digit number
Your answer
Bay Language Academy Account Information *
What are the names of the students at Bay Language Academy for which this payment should be applied?
Your answer
Legal Authorization
Authorization *
Fees for unavailable payments *
Duration *
Electronic Signature *
Enter your full name here. This acts as your electronic signature.
Your answer
Email address *
A confirmation will be sent to your email address when the automatic withdrawals have been set up.
Your answer
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