Thank you for your previous registration for Grounded.

You can pay your outstanding Grounded fees using one of the forms below.

To pay as a single payment please complete form below:

OR

To pay as via instlaments – (5 weekly payments) please complete the form below:

Name *

First

Last

Mobile Number *

Email *

TOTAL Grounded Fees to be paid *

You will need to manually calculate & enter the total as entered on your original Grounded Registration &/or the amount you are able to contribute towards Grounded Fees.

Weekly Payment Amount (Grounded Fees to be paid over 5 weeks) *

Please manually calculate & enter your Weekly payment amount (Grounded Fees Payable / 5)

By checking these boxes I understand & authorise that my card will be direct debited as follows: *

Number payments: Five (5) equal payments
Frequency: Weekly
Date of First Payment: FIRST PAYMENT WILL BE TAKEN WHEN YOU SUBMIT THIS FORM
Weekly Amount: The amount shown in Total below
Any questions relating to these payments should be directed to MEC Bookkeeper: Lea Porter (Ph: 0402 267270)

Total (This amount will debit today with four (4) further weekly payments of this amount)

$0.00

Stripe Credit Card *

Card

Name on Card

Thank you for your previous registration for Grounded.

You can pay your outstanding Grounded fees using one of the forms below.

To pay as a single payment please complete form below:

OR

To pay as via instlaments – (5 weekly payments) please complete the form below:

Contact

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