Direct Debit Agreement Form
CMCB is continuing to offer a monthly Direct Debit program for easy, paper-free billing.

By filling out this agreement, you authorize CMCB to keep your credit/debit card on file and charge you monthly according to our standard 10 month payment plan running September through June. All card information will be securely stored on-site.

Charges will be posted on or between the 15th and 20th of each month from the date of this agreement through June of the current school year (or until your CMCB invoice has a zero balance).

*** As agreements must be re-authorized yearly, all new and continuing participants of the program must fill out this form. ***

If you are a continuing participant and would like to verify which card you have on file, please email registration@cmcb.org to request this information.
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Email *
Name *
Student name(s) *
Card Type *
Card Holder Name (as appears on card) *
The last 4 DIGITS of your card number (For security purposes, a member of the registration team will call you for the full card number) *
Expiration Date (MM/YY) *
Billing Zip Code *
I authorize the CMCB to charge my credit/debit card monthly according to the agreed-upon payment plan. Charges will be posted on or between the 15th and 20th of each month from the date of this agreement through June of the current school year (or until my CMCB invoice has a zero balance). *
I acknowledge that the monthly payment amount is based on an equal division of the total tuition instead of the number of lessons per monthly billing cycle. Should I wish to discontinue this payment method, I agree to notify a Registrar immediately to arrange an alternative payment method. *
I acknowledge that if my credit/debit card cannot be processed, CMCB reserves the right to discontinue lessons or classes until the status of my account is brought to current. *
Tuition fees cover just half the cost of programming. If you'd like to add a recurring monthly donation to your monthly charge, please select or write an amount below. As a non-profit organization, the full amount of your donation is tax deductible. Thank you!
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