Credit Card Authorization Form

You authorize the scheduled charges to your credit card for the months of August, September, October, November, and December for the amounts on the invoice provided to you. A receipt for each charge will be printed and attached to your file in school, and the charge will appear on your credit card statement.

You agree that no prior notification will be provided unless the amount changes. The payments will be processed on a business day, and will be defaulted to the next business day should the payment occur on a weekend or holiday.

Should a credit card be expired or give an error, you will be notified and will be expected to provide a different card as soon as possible. If the card is not received until the next payment is due, the total amount due will be processed as one payment.

Name of Child 1 *

Grade of Child 1 *

Name of Child 2 (If applicable)

Grade of Child 2 (If applicable)

Name of Child 3 (If applicable)

Grade of Child 3 (If applicable)

Name of Child 4 (If applicable)

Grade of Child 4 (If applicable)

Name of Child 5 (If applicable)

Grade of Child 5 (If applicable)

Card Type *

Mastercard
VISA

AMEX not accepted

Cardholder Name (as shown on card) *

Card Number *

Expiration Date (mm/yy) *

Consent Declaration *

I authorize Pen and Paper Foundation to charge my credit above for agreed upon amount as stated on invoice provided., on the 15th day of August, September, October, November, and December 2023. I understand that my information will be saved to file for above mentioned transactions.

CVC Code *

Customer Signature *

Date *