Name(person completing this form):
Payment Type:
Agreement - One-Time Payment
By clicking the Authorize Payment button below, I authorize Goldey-Beacom College to charge my bank account listed below on
Date:
for the amount of
Amount: $
for
Description of Transaction:
Agreement - Recurring Payments
By clicking the Authorize Payment button below, I authorize Goldey-Beacom College to charge my bank account starting on
Starting Date:
and on day
Day of Month (1..31):
of each month following through
Ending Date:
This payment authorization is valid and to remain in effect unless I notifiy Goldey-Beacom College of its cancellation by sending written notice to: business@gbc.edu or by mail to Goldey-Beacom College, 4701 Limestone Road, Wilmington DE 19808 Attn Business Office.
Account Information
Name(as it appears on bank account):
Bank Name:
Bank Account Type:
Bank ABA Routing Number:
Bank Account Number: