Automatic Withdraw Form - JAMSpiritSites.com

Automatic Withdraw Form
Athlete’s Name: ____________________________________________________________________________
Charge my monthly tuition on the
1 st of each month.
Charge my monthly tuition on the
15 th of each month.
I Authorize Mechanics of Fitness, LLC DBA Vegas Cheer Authority to deduct from my bank
account/credit card reflecting upon the information stated in the payment information below:
ELECTRONIC FUNDS TRANSFER
A VOIDED CHECK AND A COPY OF DRIVER’S LICENSE IS REQUIRED
Name as it appears on account:
Bank Name:
Account Number:
Account Type:
( ) CHECKING ( ) SAVINGS
Routing Number:
Signature:
CREDIT OR DEBIT CARD
A COPY OF THE CREDIT / DEBIT CARD AND DRIVER’S LICENSE IS REQUIRED
Name as it appears on card:
Card Type:
( ) VISA ( ) MASTERCARD ( ) DISCOVER ( ) AMERICAN EXPRESS
Card Number:
Expiration Date:
Billing Address:
/ (MM/YYYY)
Card Security Code:
On your card, locate the final 3 or 4 digit
City: State: Zip:
Signature:
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Vegas Cheer Authority 3630 N. 5 th St. N. Las Vegas, NV 89032 (702) 410-4151 www.vcauthority.com

FINANCIAL AGREEMENT
I hereby agree that if the said amount outlined within the 2013-2014 tryout packet will be debited from my
account if not paid by the designated due dates. If at any time the above card or bank account is declined,
services and any tangible orders will be ceased until full payment is received. In addition, outstanding balances
will be turned over to the appropriate agency at the expense of the customer. I also understand that I will be
charged a $30.00 fee for any declined transactions or returned checks.
I furthermore agree that any changes made in accounts and/or credit/debit card providers, card numbers,
expiration dates etc. will be reported to Vegas Cheer Authority in order to update records to avoid any delay in
services.
ALL PAYMENTS ARE NON-REFUNDABLE!
TERMS
Cancellation clauses: If for any reason you have made a commitment to our competitive program and cannot
complete the season you have 10 days from the time you sign the automatic withdraw form to terminate your
contract and assume no additional financial responsibility. If you wish to cancel this contract, you may cancel by
mailing a certified letter to Vegas Cheer Authority. The notice must say that you do not wish to be bound by this
contract and must be delivered or mailed before midnight of the tenth (10) day after you sign this contract. The
notice must be mailed to: 3630 N. 5 th Street Ste. 100 North Las Vegas, NV 89032.
If your child is injured and will not be physically able to complete the competitive season, you must provide Vegas
Cheer Authority with a letter from the physician stating the time period they must be out for. All upcoming
tuition charges will be waived, as well as, competition charges or clothing that Vegas Cheer Authority has not yet
paid for on your athlete’s behalf. If Vegas Cheer Authority has registered and paid for your athlete to compete or
ordered clothing prior to the injury/medical problem then you will still be financially responsible for the
competition fee and/or clothing.
If you and your child are moving more than 30 miles away from VCA following joining our program you must
provide Vegas Cheer Authority with proof or a new residency (i.e.: utility bill). All upcoming tuition charges will
be waived, as well as, competition charges or clothing that Vegas Cheer Authority has not yet paid for on your
athlete’s behalf. If Vegas Cheer Authority has registered and paid for your athlete to compete or ordered
clothing prior to the move then you will still be financially responsible for the competition fee and/or clothing.
You are able to buyout of your contract for $500.00 at any point in the season.
Vegas Cheer Authority reserves the right to alter the days and/or hours of operation, the curriculum and the
amount of classes you're entitled to attend, if deemed necessary. Vegas Cheer Authority does not guarantee that
you will reach a certain level of competence within any specific time frame and that students' obtaining a certain
defined level of competence may be either delayed or accelerated due to changes in the curriculum or as
deemed necessary by Vegas Cheer Authority.
Signature of Financially Responsible Party: ____________________________________________
(Must match the information listed on the front page of this form)
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Vegas Cheer Authority 3630 N. 5 th St. N. Las Vegas, NV 89032 (702) 410-4151 www.vcauthority.com