Cathedral-Carmel School
Auto-Draft Authorization Form
2017-2018
Attached you will find an ACH CORPORATE AUTHORIZATION FORM. This form authorizes
Cathedral-Carmel School to automatically draft from your account the monthly tuition in a set
amount authorized by you. Please complete this form and ATTACH A VOIDED CHECK. Please
follow the tuition schedule to calculate proper monthly draft amounts.
*This form must be filled out each year.
We will have the option of pulling drafts on the 10th or 20th of each month.
preference below: *Please note first draft will be in JULY 2017*
Please check your
_______10th of month
_______20th of month
For auditing/documentation purposes, please fill in the total $ (dollar) amount tuition for each
month. You should refer to the attached sheet for accurate fee/tuition amounts for each month.
July 2017
August 2017
September 2017
October 2017
November 2017
Dec 2017 (REG & MAINT FEE ONLY)
January 2018
February 2018
March 2018
April 2018
TUITION
TIGER CARE
TOTAL TO BE DRAFTED
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Authorization Signature: ________________________________________
Date: _________________________________________________________
Please call the CCS Business Office with any questions at (337) 261-9484 ext 228.
*This form should be returned to the Cathedral-Carmel Business Office, Attn: Errin
Landry
ACH CORPORATE AUTHORIZATION FORM
Company Name
Tax Identification Number
Cathedral-Carmel School
72-6000271
I (we) hereby authorize Cathedral-Carmel School, hereinafter called COMPANY, to initiate
debit and/or credit entries to my (our)  Checking Account /  Savings Account (select one)
indicated below at the depository financial institution named below, hereinafter called
DEPOSITORY, and, if necessary, initiate adjustments for any transactions credited / debited in
error. I (we) acknowledge that the origination of ACH transactions to my (our) account must
comply with the provisions of U.S. law.
Depository Name
Branch
City
State
Routing Number
Account Number
Zip
Name (PLEASE PRINT)
Signature
Date
PLEASE ATTACH VOIDED CHECK
NOTE: In the case of revoked authorization, all written authorization may be revoked only by
notifying the originator in writing no later than 15 days before the next transaction effective date.
*This form should be returned to the Cathedral-Carmel Business Office, Attn: Errin
Landry