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Auto-Draft Authorization
Account Holder's Information
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Please Select the date(s) you would like your tuition to be drafted each month:
The full amount due as reflected on your monthly statement will be deducted each month. This includes any past-due amounts late-fees or drop-in fees.
 
Payment Information
Please Enter Four Digits of Card Number in Each Box
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Please enter the three digit code from the back of your card:
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Please review the above information and make sure everything is correct. By signing below you are authorizing Mosaic Church of Abilene to use NCS Services to deduct the amount on your monthly statement from your selected card at the selected frequency. You may request to stop auto-draft at any time but you must provide Mosaic Church no less than 5 days' notice prior to your next draft date.
 
Card Holder's Signature
I understand that my electronic signature will stand in place of a written signature.
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