AUTOMATIC PAYMENT REQUEST

Request an automatic payment. Use this form to set up a schedule.

Name*
First Last
Email*
Phone*
Date*
Date Format: MM slash DD slash YYYY
Payment Request Schedule*
Tell us the amount you want paid. Tell us on what dates you would like us to make your payment. Tell us the start date. You can also say things like. "Every Friday"
Consent*
I agree to the automatic payment authorization.
I authorize The Cool Panda to make automatic payments on my vacation until it is paid off using my card on file. My requested payment schedule is outlined in this form. I understand that payments are processed Monday through Friday during normal business hours. If the payment date falls on a weekend or a holiday, the payment could be made on that date but most likely will be made on the next business day.
Signature

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