BU Dance Co. Credit Card Authorization Form
This form authorizes BU Dance Co to electronically charge the card listed below for monthly tuition for my child(ren) including processing fess and applicable sales tax.
I understand that there will be a 5% processing fee assessed to the monthly tuition rate to process this payment *
Required
I understand that this payment will be process on the first week of each month. *
Required
Child(ren) First & Last Name Payment Should Be Applied To *
Your answer
First & Last Name (AS IT APPEARS ON CARD) *
Your answer
Credit Card Number *
Your answer
Expiration Date (MM/YY) *
Your answer
CVV Code On Card *
Your answer
Billing Zip Code For Card *
Your answer
Signature Of Authorization *
By typing my name in this section, I authorize BU Dance Co. to electronically charge my credit/debit card, listed above, monthly for full monthly tuition fees (including processing fees and applicable sales tax).
Your answer
I would like a receipt for each monthly transaction sent to me *
If you would like a receipt sent to you, please provide email address or phone number you would like us to use
Your answer
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