Palmetto City Ballet School – Credit Card Authorization Form

Name of Student *

First

Last

Name on Card *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Credit Card Number *

Expiration *

CVC *

Multiple Choice *

Visa
MasterCard
Discover

Email *

Class Tuition Payment Frequency *

Youth Company Tuition Payment Options *

Comment