Fusion Math Payment Authorization Form
Secure Payment Form

Order Summary:
Order Date: 02/20/18
Order Amount: 0.01
Customer IP: 
Form Instructions: This form will charge your Credit Card or debit your Bank Account (if you choose Pay By Check below) $0.01 to allow us to securely save your payment information.

Your bank may alert you that your payment is "Recurring" or the charge may appear on your Credit Card Statement as recurring but that is a system setting due to how we process the payments. You will only ever be charged for sessions that were scheduled.

By completing this form and clicking the Process Payment button below you authorize Fusion Math to automatically charge your Credit Card or debit your Bank Account bi-monthly for Tutoring Services rendered. By submitting this form you agree to Fusion Math's rates and cancellation policy outlined below.

Current Tutoring Rates:
Minimum 1 hour sessions except for special arrangements. Appointments are charged as booked plus any additional time.
General Math, Science, Verbal: 98/hr
Calculus, Advanced, Honors, AP, IB: 108/hr
Test Prep such as SAT, ACT, ISEE, SSAT: 128/hr
Same Day Bookings: 20/hr extra helps ensure a tutorís availability.
Changes made after 5pm two days prior to appt: 20/hr extra
Contact us to discuss tutoring more than one student simultaneously.
Mark's rates are not published - please call to inquire.

Cancellation and Change Policy:
Changes made for any reason after 5pm two days prior: $20 Fee
Cancellations made for any reason after 5pm one day prior: half-charge.
Cancellations made for any reason day of: full-charge.

Kindly fill in ALL fields Below and thank you for also filling in your Student's Name, School, and Grade.
Credit Card and Bank Information:     
Card Type:

Name as on Card:
Card Billing Street Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
[What is the Card ID?]
Billing Information:
First Name:
Last Name:
Address Line 2:
State (2 letters only):
Phone Number:
Email Address:
STUDENT Grade 2017-18:
How did you hear about us?: