Fillable 2020-2021 Automatic Tuition Payments (ATP) Authorization Form (Kama'aina Kids)

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2020-2021 Automatic Tuition Payments (ATP) Authorization Form (Kama'aina Kids)

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The 2020-2021 Automatic Tuition Payments (ATP) Authorization Form (Kama'aina Kids) form is 1 page long and contains:

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File type: PDF

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2020-2021 Automatic Tuition Payments (ATP) Authorization Form
We are excited to offer the safety, convenience and ease of Tuition Express® – a
payment processing system that allows secure, on-time tuition and fee payments to
be made from either your bank account or credit card.
Payments will be processed beginning with the first business day of each month.
An email address is required to access receipts online at www.MyProcare.com. 
Credit union members: please contact your credit union to verify account and routing numbers for automatic payments.
Payee Info
Payer Last Name
Payer First Name
Phone (required)
Email Address (required)
Child Last Name
Child First Name
Monthly Tuition
Morning Care
Total
1.
$
$
2.
$
$
3.
$
$
ATP Start Month
School Name
Total Monthly Tuition
$
Payment Option A (Credit Card)
❑ Visa ❑ Mastercard ❑ American Express ❑ Discover
Cardholder Name
Credit Card Number
Exp. Date
CVV#
Billing Address
City
State
Zip
Payment Option B (Bank Account)
❑ Checking ❑ Savings
Bank or Credit Union Name
Bank or Credit Union Address
Routing Transit Number (see sample below)
Account Number (see sample below)
Please note that in addition to the monthly tuition charge, the following fees shall be assessed:
• There shall be a $20 one-time processing fee assessed per family for each school year.
• There shall be a $30 service charge assessed for any returned checks.
I hereby authorize Kama`āina Kids to initiate credit card charges to the above-referenced credit card account (Payment Option A) OR,
initiate debit entries to my checking or savings account, indicated above (Payment Option B). I am required to give 10 days written
notice to cancel this authorization.
Donation
Kama`āina Kids is a not-for-profit organization. Should you wish to make a tax-
deductible donation to assist our financial aid and scholarship program, please indicate
your donation frequency and amount here:
Frequency:
❑ One-time
❑ Monthly
Donation
$
Print Name
Authorized Signature
Date
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2020-2021 Automatic Tuition Payments (ATP) Authorization Form (Kama'aina Kids)

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Completed 30 June 2021

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