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Elevate Payment Form
Automatic Credit Card Billing Authorization Form
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* Indicates required question
Customer Name
*
Your answer
Child's/Children's Name(s)
*
Your answer
Method of Payment
*
Automatic Credit Card Monthly Withdrawal (Please contact us if you do not have a card on file)
Invoiced Monthly (Pay by cash or check. Must be paid by the 10th.)
Monthly Auto Payment Date (Taken out September 2020-May 2021) *To cancel auto payment, you must email us at
elevategymnastics@gmail.com
.
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Customer's Signature
*
Your answer
Date
*
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YYYY
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