Monthly Credit Card Authorization Fields that have an * are required. Monthly Credit Card Authorization "*" indicates required fields This form allows Howell Dance to have your child's tuition charged to your credit card monthly through May 2024Use this form to convert your account to automatic monthly payments by credit card.Student's Name* First Last Name On The Credit Card* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card InformationPlease 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* Consent – authorization* I authorize Howell Dance and Vanco Services, LLC to process credit card charges to my account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the authorization. The monthly charges will be for the tuition amount + 3.5% monthly service fee.Consent – late fee* I understand that Howell Dance will charge my credit card account for any outstanding costume balances not paid by the due date with a $10 late fee.Your Name – As Your Digital Signature* PhoneThis field is for validation purposes and should be left unchanged.
