AUTOMATIC CREDIT CARD BILLING AUTHORIZATION AGREEMENT

I, the undersigned, hereby authorize My Forte Learning Services, Inc., to automatically charge my Visa, MasterCard, or American Express twice a month for any and all services rendered in connection with my child.

Name of Child *
Name of Child
Cardholder’s name as it appears on Credit Card *
Cardholder’s name as it appears on Credit Card
Billing Address *
Billing Address
Signature
Signature

 I accept and agree to the terms and conditions of the My Forte Learning “Automatic Credit Card Billing Authorization Agreement.” If My Forte Learning is unable to process my payment, I will be responsible for an alternate payment arrangement and any late fee that results.

I may cancel this Automatic Credit Card Billing Authorization Agreement at any time by submitting written notification to the My Forte Learning office.

By signing this authorization, I acknowledge that I have read and agree to all of the above. All information given is complete and accurate.