Auto Draft Form Auto Draft Form Name Name of Student Receipt to Cell Phone or Email?Cell PhoneEmailWhat 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 CardMasterCardVisaDiscoverAmerican ExpressAccount 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.