Credit Card Authorization
Type Of Card MastercardVisaDiscover
Name on card
Expiration date CVC Security code
Billing Address For Card
City State Zip Code
I authorizing White Rock Dance to charge the above credit card for tuition, costumes, and other related dance fees. I realize that if for any reason I need to stop dance payments, I must contact Karissa Agnew by email at least 5 days prior to the 1st of the month. All credit cards will be charged on the 1st of each month. *Invoices will be sent home in your child’s take home folder to be sent home by the 20th of each month.
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Document Name: Credit Card Authorization
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