ACH Recurring Payment Authorization Form

Schedule your monthly tuition payment to be automatically deducted from your checking or savings account.
Just complete and sign this form to get started!
Recurring Payments Will Make Your Life Easier:

It’s convenient. (saving you time and postage)

Your payment is always on time (even if you’re out of town), eliminating late charges.

Here’s How Recurring Payments Work:

You authorize regularly scheduled charges to your checking or savings account. You will be charged the
amount specified below each month. A receipt for each payment will be emailed to you and the charge will
appear on your bank statement as an “ILM ACH Debit.” You agree that no prior notification will be provided
unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the
payment being collected.
Please complete the information below:

Please complete the information below:
I authorize Chase Bank NA to charge my bank account
indicated below on the date stated below of each month for payment of the monthly tuition for my Child at ILM.
(Date should be between 1-3 of the month)

Parent/Guardian details
Banking Details

I understand that this authorization will remain in effect until the last tuition payment is due on May 31st of 2018 and I agree to notify ILM Academy in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next due date. If the above noted periodic payment dates fall on a weekend or holiday, I understand that the payment may be executed on the next business day. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF), I understand that ILM Academy may at its discretion attempt to process the charge again within 7 days, and agree to an additional NSF fee of $34 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH
transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my
bank so long as the transactions correspond to the terms indicated in this authorization form.