Payment Information

Membership Payment Options *

Electronic funds transfer (EFT)

Credit Card

Invoicing

One-time Payment Options *

Electronic funds transfer (EFT)

Credit Card

Membership Payment Options (UK) *

BACS	Direct Debit

Billing Cycle (payment frequency)

Billing Cycle (payment frequency DD)

(no change)

Annual

Quarterly

Monthly

Who should we contact to get the new Direct Debit mandate signed?

Billing Cycle (payment frequency BACS)

(no change)

Annual

Quarterly

Discounts apply to membership dues paid annually or semi-annually.

Note: for EL members, only annual and full two year program payment options are available.

Electronic Funds Transfer (EFT) Payment

ABA / Routing Number

Bank Account Number

Bank Name

Credit Card Payment

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Authorization Amount ($) *

***Electronic funds transfer/credit card authorization: I hereby authorize Vistage to initiate charges to the above stated credit card or bank account: (a) for the amount due at signing and (b) if any recurring billing option is selected, for the then-current dues payable to Vistage for the program in which I am enrolled at the time of the charge. (Vistage to provide a 30-day notice of fee changes.) This authorization is to remain in force through my 90-day cancellation period. In the event of a declined credit card or insufficient funds, Vistage will continue to submit a request for payment until approval for payment is received.

***Credit card authorization: I hereby authorize Vistage to initiate a one-time charge to the stated credit card. In the event of a declined credit card or insufficient funds, Vistage will continue to submit a request for payment until approval for payment is received.

Authorized Signature

clear

Invoice Payment

Invoicing frequency

Annual

Semi-Annual

Effective 10/1/24 invoiced membership dues are subject to an ~1.5% processing fee.

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