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Auto Pay Form - ACH

By submitting this form, you are agreeing to allow Congregation Har Shalom to automatically process payments for the transactions you indicate below. This Agreement will remain in effect until you cancel it in writing.

If you decide withdraw from any Programs/Classes you are registered for, or cancel your Har Shalom Membership, you are still responsible for paying any outstanding charges including the date of cancellation.

ACH payments are processed on either the 1st or 15th depending on your preference.

By typing my name in the box above, I am "signing" this agreement and authorizing Congregation Har Shalom to process payments on my Har Shalom Account.

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