Floral Image - Dallas Credit Card Form

Credit Card Authorization Form

Please complete the following secure credit card authorization form in order for us to set up your recurring credit card payment towards your tuition

Monthly Payment Amount:*

2024 TFTP Tuition (8-month billing plan)This is a custom payment plan for the 2024 TFTP program.

$560.00

Phone Number
Please enter a valid phone number.
Organization
Company Name
E-mail
example@example.com
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By signing below I hereby authorize Embodied Masculine™ to charge my credit card for the amount shown above on a monthly basis until my tuition is paid in full.
Authorization Signature

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Credit Card Authorization Form