Account FormsMember SupportPayment Authorization FormName First Last Date MM slash DD slash YYYY Select if military, LEO, or first responder Yes I amStudent(s) name(s)(Required)Date(s) of birth(Required)# of members(Required)PAYMENT AUTHORIZATION I authorize Crest Brazilian Jiu Jitsu to charge my credit card as reflected below, and I certify that I am the holder of the credit card. If my credit card changes or expires, I am responsible to inform Crest Brazilian Jiu Jitsu of those changes prior to the normal billing date.Card Type(Required) Visa Mastercard Discovery AmExName on Card(Required)Card #(Required)Exp Date(Required)CCV(Required)Billing Zip Code(Required)Billing Address(Required)City, State(Required)PhoneEmail CANCELATIONS/NSF/LATE PAYMENT POLICY I acknowledge that I can cancel my payment authorization at any time by giving notice at least 30 days prior to the normal billing date. If my card is declined for non-sufficient funds (NSF), or any other reason, Crest may attempt to recharge my account within 30 days and include an additional $25 fee for inconvenience. If for any reason, a payment is late by more than 7 days, there will be a $25 late payment fee automatically added to the charge.PHOTO/VIDEO RIGHTS By entering into this agreement, the undersigned grants the school permission to use photographs, videotapes, artwork or other likenesses of the student for marketing, trade, publishing or any other lawful purpose.Member (Parent or Guardian if under 18) - Check this box to agree to terms above(Required) Yes, I agreeOther Options Review Us!
