Auto Pay Form

Auto-Pay Withdrawal Terms and Conditions

1. This authorization is to remain in effect until you notify Boulder Pointe Equestrian and Event Center, LLC of its cancellation by giving written notice 30 days in advance.

2. All charges will be automatically withdrawn from your bank account on the 20th of the prior lesson month.

3. Prices are subject to change with a 30 day notification before your auto withdraw amount will be updated.

Lesson Scheduling
1. Your lessons will be scheduled in the Acuity System by a member of the Boulder Pointe staff within 3 days of your cleared payment.
2. You will be able to see the schedule through your Acuity account and you will have the ability to cancel any lessons you know you will miss as a courtesy to the instructor. (NOTE: There are no refunds for cancelled or missed lessons.
3. Reschedule Policy - One (1) lesson will be able to be made-up every three months. No exceptions.

_______________________________________________________________________________________________________________________________
NOTES:
1. We can prorate mid month for new clients
2. Every 3rd month in the year has 5 lessons instead of 4. The monthly rate is 4.33 lessons per month.

I authorize Boulder Pointe Equestrian & Event Center, LLC to electronically debit my bank account according to the terms outlined. I acknowledge that electronic debits against my account must comply with United States law.

* Indicates required field

Please select below what you want withdrawn each month. *

Approved Lesson Day/Time and/or Assigned Locker # *

Start Date for Auto Pay *

If Other, describe below *

If other, please list End Date *

Payment Information

Account Type: *

Checking Savings Credit Card (3.5% fee)

Name on Bank or Credit Card Account *

Bank Account Number *

Credit Card Number *

Billing Zip Code *

Routing Number (9 digits) *

Exp. Date *

Security Code *

Agreement and Signature

Signature Name *

First

Last

I understand and agree with all terms and conditions stated above. *

Yes

Phone Number *

Submit