#370, 233 West 1st Street North Vancouver BC, V7M 1B3

123 456 789

info@example.com

Goldsmith Hall

New York, NY 90210

07:30 - 19:00

Monday to Friday

Attendance Program - recurring payment

Name of Student(Required)
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Consent(Required)
I authorize Vancouver Nour Danesh Farsi School to charge my bank card above for agreed upon educational services. I understand that my information will be saved to file for future transactions on my account. I certify that I am an authorized user of this bank card. I know that I will be charged each billing period for the total amount due for that period, totally for 6 times (months) including and starting by this transaction. I agree that no prior-notification will be provided if the total payment is under my payment.
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