Credit Card Authorization Form

Credit Card Authorization

The sign-up process is almost complete. Please fill out the credit card authorization below. This website is secured with SSL. Your personal information and credit card information will be securely transmitted to us and stored following the strictest PCI guidelines. We will keep your information on file and bill each tutoring session to your card. It's ok to wait to provide your credit card info until you know we have scheduling availability for you, but you will need to fill out this form before we can confirm your first session. Contact us if you have any questions or if you'd like us to email you a statement of your account activity at any time.

* Indicates required field

Full Cardholder Name *

Billing Zip Code *

Credit Card Number *

Expiration Date *

Rates and Cancellation Policies Agreement *

Both the student and the person responsible for payment have read and agree to the MindGarden rates and cancellation policies.

Authorization *

I authorize MindGarden Tutoring LLC to securely store this credit card information, use it to pay my current account balance in full, and use it to pay for all future services/fees according to the MindGarden Tutoring rates and policies shown and updated on the MindGarden website at www.mindgardentutoring.org.

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