I understand that I will be charged the amount indicated each billing period, receipt for each payment will be provided and the charge will appear on my credit card statement. I understand that this is an automatic recurring charge process and no prior-notification will be provided before each charge.   Initial:*   
I understand that this authorization will remain in effect until I cancel it in writing via email or paper or pay off my balance in full. Initial:*   
I understand that I must notify in writing of any changes in my account information. I must provide written termination of this authorization at least 15 days prior to the next billing date.Initial:* 
I understand if my card declines or i receive a new credit card, that it is my responsibility to notify the student services bookkeeper.  Initial:*  
I understand that if I fault on this payment arrangement that I will lose the ability to pay off the debt in installments. Initial:*
 
I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this Credit Card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this authorization form.Initial:*   

By signing this form, I   First Name*   Last Name*  , am authorizing regularly scheduled charges to the credit/debit card provided, My card details will be stored in my profile and will only be used for approved purchases and agreeing to the all the terms listed above provided by Tom P. Haney Technical College.