MEMBER AUTHORIZATION FOR DIRECT PAYMENT VIA ACH

Direct Payment via ACH is the transfer of funds from a consumer account for the purpose of making a payment. Please fill out the form below which will be submitted to our Membership Director.

Name*

First

Last

Email Address*

Phone Number*

Submitted Date*

Club Number*

I authorize CENTRAL PARK TENNIS CLUB to electronically debit my account, and, if necessary, electronically credit my account to correct erroneous debi*

Yes

Account (select one) at the depository financial institution named below. I agree that ACH transactions I authorize comply with all applicable law..*

Depository Name*

Routing Number*

Account Number*

Amount of debit(s) or method of determining amount of debit(s) [or specify range of acceptable dollar amounts authorized].

Date payment to be withdrawn:*

I understand that this authorization will remain in full force and effect until I notify CENTRAL PARK TENNIS CLUB in writing that I wish to revoke thi

I authorize*

Yes

* Indicates a required field.

Please enter secure code above:*

MEMBER AUTHORIZATION FOR DIRECT PAYMENT VIA ACH

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MEMBER AUTHORIZATION FOR DIRECT PAYMENT VIA ACH

Reserve a Court

Inquire About Membership

Club Tour

Member Login

Reserve
a Court

Inquire
About Membership