Recurring Payment Authorization Form

Please fill out the following information in order to set up recurring payments.

- Step 1 of 4

Student(s) Name(s) *

Student(s) Grade(s) *

Billing Name *

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Billing Phone Number *

Billing Email *

Confirm Email

Payment Selection: I authorize Redwood Cooperative School to process my tuition payment in the manner I have selected below. *

Check (no additional fee): Checks are due by the 5th of each month. If checks are received after that date, a $50 late fee will be assessed. After two incidents of late payment, a family will be automatically switched to EFT/Bank payments in order to ensure timely receipt of tuition payment.
EFT/Bank withdrawal (1% processing fee each month)
Credit/Debit card (3.5% processing fee each month)

For EFT/Bank or Credit/Debit card, please indicate a date below when Redwood may withdraw payment each month (between 1st and 15th of the month) *

Monthly payment amount (provided by Director of Finance) *

Automatic Withdrawal from EFT/Bank Account (1% processing fee): Please complete the information below ONLY if you have selected EFT/Bank payment. (Please select one.)

Please use my EFT/Bank details from the 2022-2023 school year. They have not changed.
Please use my new EFT/Bank information below:

Bank Name

Bank City and State

Account Number

Routing Number

Credit/Debit Card Recurring Payment (3.5% processing fee): Please complete the information below ONLY if you have selected Credit/Debit card payment.

Please use my Credit/Debit card from the 2022-2023 school year. They have not changed.
Please use my new Credit/Debit card information below:

Name on Card

Card Number

Expiration Date

CVV

Billing Zip Code

For those using EFT/Bank/Credit/Debit card: I understand that this authorization will remain in effect until the billing period terminates. I agree to notify Redwood in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing 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 I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates.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 EFT Transaction or credit/debit card being rejected for Non Sufficient Funds (NSF) I understand that Redwood may at its discretion attempt to process the charge again within 30 days, and agree to an additional $50 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 EFT transactions or credit/debit transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank or credit card company so long as the transactions correspond to the terms indicated in this authorization form.

I understand and agree to all terms and conditions in this document. *

Responsible Billing Party Signature

Date Form Completed *

DD/MM/YYYY