Sign up for Reoccuring BillingI hereby authorize Lakeland Academy of Arts to charge my account selected below on the date selected below for the amount selected below. This payment authorization is valid and to remain in effect unless I notify Lakeland Academy of its cancellation by sending written notice or via email at least 24 hours prior to cancellation. * indicates required fields *Student Name: *Parent Name: *Billing Name: *Credit Card or Checking Account: Credit Card Name: Credit Card Number: Type of Credit Card: 3 Digit Code on Back: Credit Card Expiration Date: Credit Card Billing Address: Bank Account Name: Bank Account Routing Number: Bank Account Number: Bank Account Type: *Amount to be billed each billing: Weekly or Monthly billing: Specify which day of the week for weekly billing: Specify which day of the month (if monthly billing: Please add special comments here: By clicking the button below, I authorize Lakeland Academy to charge my selected bank account or Credit Card on the specified day for the specified amount for after school or dance fees.
