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Name
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Expiration Date
Payment Agreement
By checking the "I agree" box below, I authorize Scholar Warrior Martial Arts, Inc to charge my credit card for the amount specified based on the program I am registering for. I understand that the first installment will be posted to my credit card account within 48 hours of submitting this form. Subsequent installments will be posted to my account on the 1st of each month for the duration of the program until the full cost of the program has been met. I understand that I have 48 hours from the time of submission to cancel this agreement at no cost. If I need to cancel my participation in the program before it is completed for personal reasons, I understand that I must submit a written request to halt payments no later than 10 days before the posting of the next scheduled payment. I further understand that I have the option of submitting alternate forms of payment in person at the physical address of Scholar Warrior Martial Arts, Inc at 7 South US Highway 12 in Fox Lake, IL 60020. Alternate forms of payment must be submitted at least 10 days prior to the next installment.