Credit Card Authorization Form
Recurring Authorization
We are pleased to offer you a new service—the Direct Payment Plan. Now you can have your tuition payment deducted automatically from your credit or debit card. The Direct Payment Plan will help you in several ways: it’s convenient (saving you time and postage); your payment is always on time (even if you’re out of town or on vacation), eliminating late charges; it’s easy to sign up for, and easy to cancel, just sign below!
Here's How It Works
You authorize regularly scheduled charges to your card. You will be charged each billing period for the total amount due for that period. A receipt will be emailed to you and the charge will appear on your credit card or banking statement. You will notify us when your card is updated.
I agree that no prior-notification will be provided if the total payment is under $
If your bill is more than that amount, or the payment date changes, you will receive notice from us at least 7 days prior to the payment being collected.
I authorize Maestro Music, Inc to enroll me in the Direct Payment Plan. I understand that I will only receive advance notice of the charge if it exceeds the amount specified above.
Yes
No
Back
Next
Name
*
First Name
Last Name
Cell Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Membership Options
*
prev
next
( X )
30 min Weekly Lessons
(
$
119
for each
month
)
60 min Weekly Lessons
(
$
204
for each
month
)
I'm Already a Member
(
$
Free
for each
month
)
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Monthly Date of Transaction
*
15th
20th
25th
1st
All lessons are pre-paid, so transactions must occur on or before the first of the month for the recurring plan. Example: Pay on the 20th of January for lessons occurring in the month of February.
I authorize Maestro Music Inc to charge the card indicated in this authorization form according to the terms outlined above. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the preceding business day. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the business in writing of any changes in my account information or termination of this authorization at least 14 days prior to the next billing date. This payment authorization is for the type of bill indicated above. I certify that I am an authorized user of this credit card or debit card and that I will not dispute the scheduled payments with my credit card company or financial institution provided the transactions correspond to the terms indicated in this authorization form.
*
Date
*
/
Month
/
Day
Year
Date
Submit
Should be Empty: