GREATER WATERBURY YMCA
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Billing Information Update
Member Name
Required
Barcode Number
ELECTRONIC FUNDS TRANSFER (EFT) AGREEMENT
I (we) hereby authorize the Greater Waterbury YMCA to charge my (our) account monthly, in the amount named, as such amounts become due without any further authorization. It is understood that this agreement shall continue indefinitely and will terminate only when authorized in writing by me (us) and when I (we) have returned my membership card. The YMCA reserves the right to adjust monthly debit entries for uncollected fees, adjust for change in membership category, and to terminate this agreement due to nonpayment of membership fees. EFT and credit card deductions are made automatically on the 15th of each month. The YMCA administers a non-sufficient fund fee of up to $30, in the event that your payment is unable to be processed. Bank processing times vary depending on your financial institution. Please note that your bank may also charge an additional non-sufficient fund fee.
Account Type
Checking
Savings
Bank Name:
Routing Number
Account Number (Last Four Digits)
Card Type:
Master Card
Visa
Credit Card Number (Last Four Digits)
Exp. Date
Current Monthly Charge
New Monthly Charge
The signature below states my understanding that I have agreed for the Greater Waterbury YMCA to draft the account indicated above perpetually, for the draft amount indicated above until I cancel my membership. Cancellations must be done in writing via email or by submitting them on out website: www.waterburyymca.org. Fees may change with 30-days notice. I understand that a minimum of 30 days is required to terminate this agreement.
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