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Automatic Payment Form
Please complete this form to enroll in monthly auto-pay. Enrollment Deadline: 10/15/23
*Auto billing will be withdrawn on the following dates: September 1st, November 1st, January 1st, March 1st & May 1st.
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Email
*
Your email
Please check below if you wish to keep your current card on file enrolled for auto pay for the 23-24 dance season.
*I understand that if it expires during the 23-24 season that I must notify PDA teachers with an updated card one month prior to its expiration.
Please continue to use my previous card on file
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Dancer's Full Name
*
Your answer
Full Name As It Appears On Card:
*
Your answer
Email for Receipts:
*
Your answer
Card Number:
*
Your answer
Expiration Date:
*
Your answer
3-Digit Security Code (on back):
*
Your answer
Billing Zip Code:
*
Your answer
Digital Signature:
*
Yes, I give authorization for Precision Dance Academy to charge the above card.
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A copy of your responses will be emailed to the address you provided.
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