Name *

Name

First Name

Last Name

Email Address *

Bank Name *

Enter the full name of the bank

Bank Routing Number *

Enter the numbers located on the bottom left half of the check

Bank Checking Account *

Enter the numbers located on the bottom right half of the check

Name on Account *

Name on Account

Enter the full name used for the checking account

First Name

Last Name

Parent Address *

Enter full home address here

Parent Home Phone Number *

Enter your home phone number here

Parent Cell Phone Number *

Enter your mobile phone number here

Authorization

I authorize ATAM to charge my account

Signature *

By typing your name below, you are signing a digital signature.

Date *

Date

YYYY

Checking Account Update Form