ACH Payment Balance on Initiation Fee

Direct Payment  via  ACH  is  the  transfer  of  funds from  a  consumer account  for the purpose of making a payment.  Your submission will be emailed directly to our Membership Director.

Option 1

Balance owing $5000*

Option 2

Balance owing $2000*

Option 3

Balance owing $500*

Email Address*
Phone Number*
Set Date
Club Number*
I authorize CENTRAL PARK TENNIS CLUB to electronically debit my account, and, if necessary, electronically credit my account to correct erroneous debi*
Depository (Bank) Name*
Routing Number*
Account Number*
Amount of debit or method of determining amount of debit(s) for initiation fee balance*
Set Date
I understand that this authorization will remain in full force and effect until I notify CENTRAL PARK TENNIS CLUB in writing that I wish to revoke thi
I (we) authorize*
* Indicates a required field.
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