Home » Autopay Form If you would like us to automatically bill your card each month, please complete and sign the authorization below, and press submit. We will automatically charge the credit card you designate on this form on the 25th of every month. If you want to stop automatic payment, or change the card you use for automatic payment, please contact the front desk at 310 451-5657, or email@example.com. Student Name (required) Your Email (required) Billing Address (required) Billing Address Line 2 City (required) State (required) Zipcode (required) Last 4 Digits of Credit Card (required) Expiration Date (required) MM ---010203040506070809101112 DD ---2018201920202021202220232024202520262027202820292030203120322033 I authorize the automatic charging each month of The Friends of the Brentwood Art Center tuition to my credit card by The Friends of the Brentwood Art Center. Check here to accept.