| PAYMENT HISTORY REQUEST FORM |
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| Please allow up to 7 days for processing and mailing. |
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| I would like to receive a paper statement at my child's next lesson. |
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| I would like to have a paper statement mailed to my home. |
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| I would like to have an electronic statement emailed to me. |
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| If you are requesting mail (USPS or email) please also fill out the following: |
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