Dancercise Kids Center Payment Form

Center Invoice Payment Form

For childcare centers to pay an invoice from Kids Fun, Inc. DBA Dancercise Kids. Please note this form will apply a 5% convenience fee for online payments.
Center Name
Childcare Center Name
Email
example@example.com
Invoice #
Please provide the Dancercise Kids invoice number if possible; if more than one, please separate with commas
Amount To Pay*
Please enter the total amount you are paying today.
Total Amount

My Products

USDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Terms Of Payment

I agree that Kids Fun, Inc will charge my credit card for the amount shown above.

By typing my full name below, I am signing this registration form electronically. I agree that my electronic signature is the legal equivalent of my manual signature.
Electronic signature of card holder*

First NameLast Name
Signature Date*

MonthDayYear
Date
Should be Empty: