ach payment form



Terms of Service
Account to chargerequired

See the source image

This authority is to remain in full force and effect until Ursuline Academy of Dallas has received written notification from the undersigned of its termination or the account balance has been paid in full. Written notification to Ursuline Academy of Dallas should be addressed to the attention of the Finance Office at 4900 Walnut Hill Lane, Dallas, TX 75229 and be received twelve days prior to scheduled withdrawal date.
Draft DaterequiredSelect one​
Select one​
I authorize Ursuline Academy to make automatic withdrawals from my bank account.​
Must contain a date in M/D/YYYY format