Auto Draft Form

"*" indicates required fields

Name of Parent/Guardian*

Name of Student*

Location Name*

Cell Phone*

Receipt to Cell Phone or Email?*

What is your Cell Phone to Send Receipt*

What is your Email to Send Receipt*

Address*

City, State and Zip Code*

Agree*

Please choose either CREDIT/ DEBIT CARD for account authorization. Please give us written notification 10 days prior to cancellation date.

Untitled*

Please Check to give Authorization For Recurring Card Transactions

Authorize*

I (we) hereby authorize MATI CLUBS to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries in error, to my/ our CREDIT CARD account indicated below. This authority is to remain in full force and effect until MATI CLUBS has received written notification to terminate authorization. I understand and agree that my credit/ debit card will be charged the amount listed below on the 1st day of each month.

Amount to be Charged each Month*

Credit Card*

Account Holder Name*

Account Number*

Expiration Date*

CVV*

Billing Zip Code*

Submit*

By Clicking Submit you agree that we will charge your card as according to this agreement.

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