Families have the option to pay one time or for the entire season (monthly) by Credit/Debit.  Please note a fee of 2.75% is added.  Please print out, complete and mail along with the registration form.

_______VISA        _______MASTERCARD    ______DISCOVER    _______AMERICAN EXPRESS

STUDENT'S NAME:_____________________________________________________________

Card Number:__________________________________________________________________


             Expiration Date:  ____/____      Security Code on back:_______   Billing Zip Code: _________


Name as it appears on card:________________________________________________________


____  AUTO-PAY:  I would like my credit card automatically charged on the first of the month.  I am aware a fee of approximately 2.75% will be applied.

____RECITAL COSTUME:  I would like my credit card automatically charge on 11/12/2012 for recital costume(s). I am aware of fee of approximately 2.75% will be applied.

____ TODAY:  I would like to register my student for dance classes.  Please charge my card ONE TIME  for the first month of tuition, only.  I am aware of fee of approximately 2.75% will be applied.

I hereby authorize Toni Schwartz Studio of Dance to charge the above credit card as I have checked above.



X______________________________________
     Purchaser's Signature


     _________________________________________
     Cell phone number for receipt