Racquet Club EFT Authorization

Utilize this form to enable Autopay for your RC account.

EFT’s will occur on the 6th of each month for balances accrued through the end of the last month.

You must either enter bank information, or put a credit card on file.

*Credit Cards will be charged a 3% fee. ACH payments will be charged a 0.01% fee.

Name *

First

Last

Email *

Bank Name

What type of Bank account is this?

Bank Account Number

Routing Number

Credit Card Number

Expiration Date

Card Security Code

EFT Terms and Agreement *

I agree to the terms below and wish to enable Autopay for incidental charges on my Racquet Club of Ann Arbor Account

Racquet Club of Ann Arbor membership includes access to a house charge account to be used for service and incidental purchases during the month. The Electronic Funds Transfer (EFT) system retains Credit Card or banking information that is processed at the end of each billing period to pay the balance on this account via Credit Card charge or Automated Clearing House (ACH) bank transfer.

I hereby authorize the Racquet Club of Ann Arbor to Debit the Credit Card Provided or the Bank Account referenced herein, via the Automated Clearing House (ACH) system, according to the parameters specified herein.
This authority will remain in effect until the payment(s) are completed as specified herein. If a payment is returned for any reason I acknowledge that I am subject to a rejected item fee of $25 or the maximum amount allowed by law.

The use of Credit Cards may be subject to a CC convenience fee of 3% on future charges.

Signature

To sign this form, please enter your name and today’s date.

Name *

First

Middle

Last

Today's Date *

Utilize this form to enable Autopay for your RC account.

You must either enter bank information, or put a credit card on file.

Signature

Address

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