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General Pre Authorized Monthly Payment Form
General Pre Authorized Monthly Payment Form
Date:_________________________________
Billing Name:___________________________
Student Name:_________________________
Select your program:
$60.00/ month plus HST:
Karate Kids (ages 4-7) Kardio Kickboxing
Signature:________________________________________________________
*Please note that for chequing and savings account option, we require a void cheque or pre authorized payment
form (usually available through your bank or credit union).Please return this completed form to Kick City.