I hereby authorize Madison Teachers Inc (MTI) to initiate monthly debit or charge entries for the payment of my annual dues. I hereby authorize said payment to MTI of my annual membership dues for the school year, and each year thereafter beginning in [label_start], with the amount of my monthly payment being my annual dues obligation divided by [payments] months ([label_start] – [label_end]). A record of each transaction will appear on my monthly bank/credit card account statement and will serve as my receipt. My authorization is in full force and effective until I terminate this agreement by notifying MTI in writing. I understand my written notification to MTI must be made by the 15th of the month for this agreement to be changed in any manner or be terminated in the following month. I further agree that if a withdrawal unsuccessful due to lack of funds, a suspended account, or similar reason, MTI is not responsible for any resulting overdraft fees, late fees, or other resulting charges.
Note: To cover the transaction costs of using a credit or debit card, a [service_fee] fee will be assessed with each payment.
