DIRECT DEBIT AUTHORIZATION

I authorize Jackson Theological Institute (JTI) to make charge(s) to my bank in order to pay for tuition and fees as billed by the Institute for classes in which I enroll. I understand and agree that this authorization shall remain effective until terminated in writing by student and confirmed termination from JTI.

Student Name *

First

Last

Start Date *

Please Select a Learning Method *

Online
Hybrid

Please Check a Degree Plan *

Bachelor
Masters
Certificate
Audit

Please Select a Payment Plan *

Pay-As-You-Go
Split Payments 40% - 40% - 20%

Bank Name *

Routing Number *

Bank Account Number *

Account Type

Checking
Savings

Bank Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Please answer this simple captcha to help us eliminate spam *

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Comment

Or download the form in PDF format and email it back to registration@jtinstitute.org

DOWNLOAD DIRECT DEBIT AUTHORIZATION FORM

Jackson Theological Institute (JTI)
2024 W. 15th St., Suite F154
Plano, TX 75075
Phone: (972)688-6611

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