Student's Name*

CSD Holdings, LLC dba At-Home Tutoring Services

Please select the local branch to which sessions will be delivered*

Austin
Boston
Dallas
Denver
Fort Bend County
Greater New Orleans
Houston
The Woodlands: Kingwood/Humble/Spring

Beginning

Date

At-Home Tutoring Services will provide tutoring services to

Services to

Client's parent/guardian verification*

Type your full name in field in ALL CAPS in the field above to acknowledge that you have read and understood all payment policies above.

Cancellation policy: Any session cancelled within 24 hours regardless of reason will be charged a fee of 100% session rate.

Any invoices unpaid by the last day of each calendar month are subject to a finance charge/late fee of 1/2% (one-half of one percent) of the invoice balance and all tutoring will be suspended.

By checking this box, I acknowledge that I have read and understood the information above.

At-Home Tutoring Services will try its best to link the client with a tutor that best suits the academic needs, personality, and timely demands of the client. If the client is uncomfortable with a tutor or the manner in which tutor delivers services, At-Home Tutoring Services will make every reasonable attempt to link the client with a tutor that meets the client’s individualized needs. The client further agrees he/she will not directly solicit the services of the tutor employed by At-Home Tutoring Services and will not personally hire the tutor unless such placement is made through At-Home Tutoring Services.

Acknowledgement*

By checking this box, I acknowledge that I have read and understood the information above.

Client's Parent/Guardian Verification*

Type Full Name in Type your full name in field in ALL CAPS in the field above

Date*

AT-HOME TUTORING SERVICES

AT-HOME TUTORING SERVICES CREDIT CARD AUTHORIZATION FORM

We require a valid form of payment to be kept on file as security for payment of your student’s tutoring sessions. Your credit card on file will be charged on or around the 10th day of each month for sessions delivered in the preceding month. For example, sessions from January 1-January 31, would be billed on or around February 10.

Please fill out and return this form to activate ACH or credit card billing for charges due on your At-Home Tutoring Services account.

Your bank account or credit card will be billed monthly until At-Home Tutoring Services receives written cancellation of service.

Preferred Payment Type*

ACH/E-Check
Credit Card

ACH/E-Check

Bank Name*

Bank Account Type*

Consumer Checking
Consumer Savings
Business Checking
Business Savings
N/A

Routing Number*

Account Number*

Credit Card

Card Number*

Security Code*

Expiration Date (Month & Year)*

Card Holders Name*

exactly as it appears on account/card

Billing Address*

City

State

Zip*

Card Holder Phone Number*

Email Address to Send Receipts*

Card Holder Verification*

Type your full name in ALL CAPS in the field above

Date of Signature*

ACH/Credit Card Update Form

ACH/Credit Card Card Update Form

CSD Holdings, LLC dba At-Home Tutoring Services

ACH/E-Check

Credit Card

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