22-23 Credit Card/Checking Authorization Form
This authorization will remain in effect until written notice of withdrawal is received by the Afterschool  program, childdevelopmentcenter@lovejoyisd.net .

The credit card/checking account on file and listed below will be charged beginning October 2022 and end May 2023 on the following dates:

October 3, 2022
November 1, 2022
December 1, 2022
January 9, 2023
February 2, 2023
March 1, 2023
April 3, 2023
May 1, 2023



Sign in to Google to save your progress. Learn more
Name on Credit Card: *
Select Card Type: *
Last 4 Digits on Credit Card: *
Expiration Date: *
Student's Name: *
Student's Home Campus: *
By initialing below, you authorize the Afterschool Program to charge your credit card on the dates above for Afterschool tuition. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Lovejoy ISD. Report Abuse
Google Forms