Preferred Customer Summer Enrollment Form
Please complete all required information with an *.
Are you...
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Enrolling
Renewing
Updating
Pausing
Cancelling
Please Choose a Level:
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Basic (free)
Premium ($9.95/yr)
Full Name:
*
Business Name:
Shipping Address:
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City:
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State:
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Zip Code:
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Email Address:
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Telephone Number:
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What is Your Preferred Payment Method?
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Credit Card (Automatic)
Credit Card (Invoice)
PayPal (Invoice Only)
PayPal Email (If Applicable):
First Set of Credit Card Digits (If Applicable):
Second Set of Credit Card Digits:
Third Set of Credit Card Digits:
Last Set of Credit Card Digits (If Applicable):
Credit Card Expiration xx/xx:
Credit Card CVV:
Billing Address:
Desired Billing/Invoice Date:
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1st Available
15th of the Month
20th of the Month
Curriculum Style
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City Bears
City Bears w/ Extra Activities
Country Bears
Country Bears w/ Extra Activities
Basic Kits:
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Construction Paper Materials:
Toddler Copies:
Toddler Combo Copies:
Preschool Copies:
Preschool Combo Copies:
Toddler Supplies:
Preschool Supplies:
Parent Newsletters:
Cubbie Tags:
Menu:
None
Lunch
Snack
Alternating
Both
School Year Curriculum (September - May):
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Yes
No
Maybe
This space is for any additional information or questions you may have.
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