Nov 30, 2021 10:24 PM

All students must provide a valid credit card.
(Visa/Mastercard/Amex Accepted ONLY)

This credit card on file is allowing CA Dance Xpress / Dance Xpress New Jersey to charge your account with any outstanding bills, plus late fees on the 11th of each month.

All credit cards will be used for guaranteed payment.
All credit card transactions will include a 3.5% processing fee.
Debit Cards may be used but CA Dance Xpress and Dance Xpress New Jersey are NOT responsible for any over draft fees your bank may charge you!!

Please initial below if you would like to JOIN our AUTO –PAY program which allows you to be worry free of all bills and ALWAYS ON TIME with NO LATE FEES.
YES PLEASE! _________

Student’s Name

____________________ Circle One
Name of Card Holder Visa/Mastercard/Amex

_____________________ ______/______ ___________
CREDIT CARD # Expiration Date 3 Digit Code

______________________________ ____________
Billing Address Zip Code

I agree to have this credit card billed for the full amount due plus any applicable fees in
the event that another form of payment is not received before the 11th of the month.

_____________________________ ____/____/_____
Signature Date
**Costume deposits are due in October and balances are due in February. We will automatically charge your costume fees to this card unless stated otherwise.**