Pre-Authorized Payment

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Credit Card Selection (please note: visa debit is not accepted) *

MasterCard

Visa

Credit Card Number *

Expiration *

CVV *

Cardholder Name as it Appears on Card *

Students First Name *

Students Last Name *

I here by authorize Dance Discovery Inc. of Canada, or its successors, assignees or transferees, to draw on my account with my financial institution, for the purpose of paying the lesson and costume fee installments issued by Dance Discovery Inc of Canada or its successors, assignees or transferees, or of any replacement policy, any applicable charges and any applicable sales tax. Installments are scheduled for September 1, 2020, December 1, 2020, and March 1, 2021. I authorize Dance Discovery Inc. to collect, use and disclose any of this personal information, subject to the law, for the purposes of facilitating the payment of lesson and costume fees related to my account. I confirm that all individuals whose personal information is contained in the document have authorized that I agree to the above on their behalf. *

Acknowledge

I am aware of the two week cancellation policy that is set in place by Dance Discovery. If I wish to discontinue lessons and cancel the payment, my notice must be received two weeks before the next installment is due in order to stop the payment. If the two week notice is not received the next installment will be processed. All lesson and costume fees are non refundable once processed. I understand that if the payment is not approved at the time of processing there will be a $30.00 service charge billed to my account. *

Acknowledge

Cardholder's Authorized Signature ( Please Type Name in Full) *

Submit

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