ACH Payment Balance on Initiation Fee

Direct Payment via ACH is the transfer of funds from a consumer account for the purpose of making a payment. Your submission will be emailed directly to our Membership Director.

Option 1	Balance owing $5000*
Option 2	Balance owing $2000*
Option 3	Balance owing $500*

Name*

First

Last

Email Address*

Phone Number*

Submitted Date*

Club Number*

Financing Option*

By choosing the option above, I accept all terms and conditions of the CPTC Financing Agreement.*

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 (Bank) Name*

Routing Number*

Account Number*

Amount of debit or method of determining amount of debit(s) for initiation fee balance*

Date of payment to be withdrawn*

This form is also our submission for monthly dues collection*

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Date payment to be withdrawn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 (we) authorize*

Yes

* Indicates a required field.

Please enter secure code above:*

ACH Payment Balance on Initiation Fee

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ACH Payment Balance on Initiation Fee

Reserve a Court

Inquire About Membership

Club Tour

Member Login

Reserve
a Court

Inquire
About Membership