authorize - Hope Learning Center

Transfer Authorization Form

Transfer Instructions

Please fill out the below form to authorize Hope Learning Center to initiate the following recurring ACH transfer from my account.

Name

First

Last

Authorize Name: select

Financial Institution Name:

Financial Institution Routing Number:

Account Number:

Please select account type

Checking
Savings

Dollar Amount:

First Transfer Date:

Recurring Frequency:

Monthly

Agreement

I, the Accountholder, understand that this authority will remain in effect until I notify Hope Learning Center in writing of the termination of this authorization at least 5 days prior to the next scheduled transfer. I agree to maintain a sufficient balance in the referenced deposit account to fund the full debit amount on each scheduled transfer date or else I will incur a $25 late fee. I acknowledge that this ACH transfer must comply with U.S. Law. Hope Learning Center reserves the right to revoke this authorization at any time.

Pay Schedule

Please note that should your payment that is due the 1st of each month, fall on the weekend or a holiday, your account will be debited the next following business day.

Optional Scholarship Donation Amount

Would you like to support a student in need? You can make a monthly contribution to our Scholarship Fund. Any amount helps! This is tax-deductible, and you can opt out at any time by contacting us.

Authorize Consent

By submitting this form, you confirm the information provided is accurate and consent