ach payment form



I hereby authorize Ursuline Academy of Dallas to initiate a monthly withdrawal from my account for my daughter’s tuition account. If applicable, Bear Necessities charges, parking, student trips and draft fee will be included in the draft amount. The drafts will begin June 2022 and continue through April 2023 on the 3rd or 18th day of each month. If such days occur on a Saturday, Sunday or bank holiday, the withdrawal will occur on the next business day. If necessary, I authorize credit entries and adjustments for entries in error to my checking or savings account.
Account to chargerequired


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
Terms of Service