AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (Electronic Funds Transfer)
PRICING
One class - $65.00/Month
Two classes - $110.00/Month
Three classes - $160.00/Month
Four classes - $205.00/Month
Five classes - $245.00/Month One Dancer Max
Six classes - $275.00/Month
Seven classes - $305.00/Month
Eight classes - $335.00/Month

One Dancer Max $245.00/Month One Dancer Max
Two Dancer Max $365.00/ Month Two Dancer Max
Three Dancer Max $395.00/ Month Three Dancer Max

Musical Theatre - $5/Month-added to total tuition (Materials Fee)
Aerial - $65/Month-added to total tuition (Equipment Fee & Limited Class Size)
Email address *
Dancer's Last Name *
Dancer's First Name(s) *
I understand and accept the following: *
I understand and accept the following: *
I understand and accept the following: *
I hereby authorize Chase Bank to initiate entries to my Financial Institution:
Debiting Account - Your Financial Institution *
Name on Account *
Routing Number (from check not deposit slip) *
Account Number *
Amount to be debited per month: *
Signature of Debiting Customer (Please type your Name as Signature) *
Date of Signature *
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