CREDIT CARD

INFORMATION

Families have the option to pay one time or for the entire season (Monthly) by Credit/Debit.  Please note a fee of 3% is added.  Please print out, complete and send along with the registration form.


______VISA    _______MASTER CARD    _______DISCOVER     _______AMERICAN EXPRESS    

______CREDIT CARD     ______DEBIT CARD


STUDENT NAME:____________________________________________________________________________________________


Card Number:_______________________________________________________________________________________________


Expiration Date:  _____/_____        3-4 Digit Security Code on back:  _______          Billing Zip Code:  _______________


Name as it appears on card:  _________________________________________________________________________________


Cell Phone Number for Text Receipt:  __________________________________________________________________________


_____AUTO-PAY.  I would like my credit card automatically charged on the first of the month.  I am aware a fee of 3% will be applied.


_____RECITAL COSTUME:  I would like my credit card automatically charged on 11/09/19 for the recital costume(s).  I am aware a fee of 3% will be applied.


_____TODAY ONLY:  I would like to register my student for dance classes.  Please charge my card ONE TIME for the first month of tuition and registration fee, ONLY.  I am aware a fee of  3% will be applied.


_____COMPETITION ENTRY FEES:  I would like Competition Entry Fees automatically charged on their due date.  I am aware of fee of 3% will be applied.


I hereby authorize Toni Schwartz Studio of Dance to charge the above credit card as checked.   I understand there are NO REFUNDS.


X__________________________

      Purchaser's Signature




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Toni Schwartz
Studio of Dance