377 Nahatan St.
Norwood, MA 02062
(781) 929-5192
[email protected]
www.merrymelodymusicacademy.com
Forms of Payment
Did you know that you have four easy choices to pay your invoices?
1.
2.
3.
4.
Mail a check.
Set us up on your own online Bill Pay with your bank.
Pay with Intuit Payment Network using the “pay online” link at the bottom left of your invoice.
Set up recurring billing. You will still receive an invoice by mail each month for your records, but
you will not need to do anything more to pay your invoices. The total invoiced amount will be
deducted from your account automatically on the 18th of each month. If you are interested in
this option, please fill out the form below and mail back to us. You may also fill out this form on
our secure page at https://www.merrymelodymusicacademy.com/recurringbilling.html.
RECURRING BILLING AUTHORIZATION
Student Name _____________________________ Phone Number ____________________________
Name on Account __________________________ Bank Name _______________________________
Bank Routing Number _______________________ Bank Account Number ______________________
I would like receipts emailed to: __________________________________________________
Bank Account Type: (Circle one) Checking / Savings / Business Checking
I hereby authorize Merry Melody Music Academy to automatically debit my bank account listed above on
the 18th of each month for the amount owed to Merry Melody Music Academy, Inc. as detailed in the
monthly invoice received by the 5th of the month.
I agree to notify Merry Melody Music Academy in writing of any changes in my account information or
termination of this authorization by the 1st of the month.
I understand that cancellations must be made in writing and I will not dispute Merry Melody Music
Academy’s recurring billing with my bank so long as the amount corresponds to terms indicated in this
contract.
I guarantee and warrant that I am the legal cardholder/duly authorized check signer on the above
account(s), and that I am legally authorized to enter into this recurring billing agreement with Merry
Melody Music Academy.
_______________________________________
Signature
_______________________________________
Date
_______________________________________
Printed Name