HOLD MEMBERSHIP

**IMPORTANT! YOU WILL RECEIVE A CONFIRMATION EMAIL AFTER THE PROCESS IS COMPLETE. IF YOU DO NOT RECEIVE AN EMAIL, YOU DID NOT SUBMIT THE FORM CORRECTLY.**

Read more about holding your account here.

Students Name (First, Last): (required)

Account Holder's Name. *Who is Paying*
(First, Last): (required)

Your Email: (required)

**You will receive a confirmation email.**

Why are you holding your account?

Account you wish to use for payment:

Type of Account:
Name on Account:
Last 4 Digits of Account/Card Number:

I UNDERSTAND (required):

1. This constitutes as my 31 days written notice for hold and my payments will change ($25 /mo.) AFTER the next billing cycle per the agreement I signed. I understand and agree that the account above will continue to be charged the hold amount for subsequent months per the signed agreement of 31 days written notice.

2. I need to keep a copy of the confirmation email sent after I submit this form. If I don't receive a confirmation email I will resubmit this form until I have received the confirmation. However, if I am still having trouble I will need to email info@payment-company.com to notify The Payment Company to receive additional instructions on submitting the online form. The confirmation email is my proof of my hold request and I understand that until I have submitted it successfully, I have not put my account on hold. Putting my account on hold is not completed until the HOLDING STUDENT has a copy of the cancellation. Secure copies are kept on the server and time/date stamped.

3. I understand that even if I didn't use my membership that I am not eligible for any type of refund, per the agreement I signed. I also understand that if I cancel while I am on "hold" I will still be charged the $25 for the next month. If I choose I can reinstate my membership during that month and will have a $25 hold credit to go towards my monthly payment.

4. By checking the following box I understand and agree to the Membership Policies and have read the FAQ regarding our rules, payments, cancellations, holds, etc.

5. I agree and confirm that I am 18 years or older and if I am not the student who this notice is concerning, I confirm that I am the parent or legal guardian of the above student.

I UNDERSTAND AND AGREE TO ALL OF THE ABOVE:

Please type in the letters below:
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Then click "Send" below: