Credit Card Authorization - Howell Dance Dance Classes Howell NJ, Dance Lessons Monmouth County NJ

Credit Card Authorization for Monthly Tuition Payments for Howell Dance
9/2024 – 5/2025

Fields that have an * are required.

"*" indicates required fields

Student's Name*

First Last

Name On The Credit Card*

First Last

Address*

Street Address City State ZIP Code

Please charge monthly payments to my credit card account, below. The charge will be your for child’s tuition amount + 3.5% monthly service fee.

Credit Card Number*

Exp. Date*

Security Code*

Billing Zip Code*

Your Name – As Your Digital Signature*

Phone

This field is for validation purposes and should be left unchanged.