2026-2027-Season #15                                          Autopayment Authorization Form

All families are required to enroll in automatic payment for dance tuition to ensure convenience and timely processing. Families may choose one of two payment processing dates: the 1st or the 5th of each month, allowing you to select what best fits your financial schedule.

Payments will be processed on your selected date. Any declined payment will incur a $25 NSF processing fee. It is the responsibility of each family to ensure that card information is accurate and up to date, the card is unlocked, and sufficient funds are available on the scheduled payment date.

Effective June 1, 2026, qualifying credit card transactions will incur a 3% credit card processing fee. This fee applies to qualifying Visa and Mastercard credit card transactions only.

Accounts with unpaid balances after the 7th of the month will result in the dancer being unable to attend classes until the account is brought current.

Late Fee:
A $25 late fee per student will be applied to any unpaid tuition after the 7th of each month.

Tuition is non-refundable and cannot be transferred or credited to another student’s account.

Forms of Payment Accepted:
EDA accepts cash, debit cards, and Visa or Mastercard credit cards. No hundred-dollar bills or checks accepted.

Cash payments are accepted; however, a valid card must remain on file at all times. Families paying with cash must submit payment at least 24 hours prior to their selected automatic payment processing date to prevent the card on file from being charged automatically.

Please plan ahead—if the 1st or 5th falls on a weekend or holiday, cards on file will still be processed on that day.

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Email *
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 $25 NSF fee will be added to dancers' account.  (Please select one) *
List what the one-time payment authorization is  *
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) *
Email of cardholder: *
Notice:  I authorize the above-named business to charge the debit or 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 debit or 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. All credit cards will incur a 3% surcharge. Debit cards will not be charged any surcharges.
Initial Below Acknowledge
 *
Date of agreement: *
MM
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DD
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YYYY
Signature of cardholder: *
I, the undersigned, authorize Elite Dance Academy to charge my debit or credit card account indicated above for the amount indicated above on or after the date indicated in this agreement. This payment is for monthly dance tuition.
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