Noto

Payment Authorization & Autopay Agreement

A valid payment method on file is required to enroll and remain active in any program with Teach Me Ms. Amahni. This form authorizes recurring charges to your card or account according to your selected program's billing terms. Please read through each section carefully before signing.

Cardholder First Name*

Cardholder Last Name*

Email*

Phone Number*

Student First Name*

Student Last Name*

Payment Info*

Payment amount:

$1.00

Total to pay:

$1.00

I authorize Teach Me Ms. Amahni to charge the payment method on file for all program fees, including the Academic Placement and Orientation Fee, monthly tuition on a 28-day autopay cycle, and any applicable late fees, and I understand this authorization remains in effect for the duration of my enrollment.*

I understand that payment for both the Academic Placement and Orientation session and my three-month enrollment term will be collected at the time of booking, and that my enrollment term begins on the date of my child's first private tutoring session.*

I understand that a valid payment method on file is required at all times to remain actively enrolled, and that enrollment will be paused if my payment method becomes invalid or is removed without a replacement.*

I understand that if a payment fails or is declined, I have 5 calendar days to resolve the issue before sessions are suspended and late fees begin to accrue, and that suspended sessions are not eligible for makeup or credit.*

I understand that if Ms. Amahni is unable to reach me for more than 7 days despite multiple attempts, sessions will be paused until communication is reestablished, and that enrollment may be formally terminated if communication is not reestablished within a reasonable period as defined by Ms. Amahni's sole discretion. I also understand that outstanding balances continue to accrue during any suspension period.*

I agree to contact Ms. Amahni directly to resolve any billing concern before filing a chargeback or payment dispute, and I understand that initiating a chargeback without prior communication is a breach of this agreement.*

I understand that payment is due on the invoice date with no grace period, that a $35 late fee applies immediately for any overdue balance, and that an additional $35 accrues for each week the balance remains unpaid.*

Date*

Signature*