2025-2026                                                                  Credit Card Authorization Form-Autopayment
Sign and complete this form to authorize Elite Dance Academy to make a monthly charge to your credit card listed below. By signing this form, you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a monthly transaction. Transactions will be discontinued by a 30 day drop notice. A new signed authorization is required at the beginning of each new season; card expires or change of card payment.
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Monthly Tuition Amount: *
Tuition payment date options are either the 1st or 5th of the month. It is the responsibility of the card holder to ensure that card is unlocked, and funds are available.  In the event card is declined a $10 fee will be added to dancers' account.  (Please select one) *
Type of card *
Cardholder name (first and last) *
Billing Address (street, city, state) *
Zip Code *
Card number: *
Expiration date: *
CVV code (on back of card): *
Dancer's name(s) *
Cardholder Email: *
Notice:  I authorize the above-named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/service described above, for the amount indicated only; this agreement is valid for one year from the date signed. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated in this form. Initial Below Acknowledging *
Date of agreement: *
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Signature of cardholder: *
I, the undersigned, authorize Elite Dance Academy to charge my credit card account indicated below for the amount indicated below on or after the date indicated in this agreement. This payment is for monthly dance tuition.
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