All families must set up their Direct Payment Plan through Automatic Bank Draft in order to be enrolled in the upcoming dance season.

If you participated in our Direct Payment Plan in the past and would like to use the same banking information, please authorize here in the following form. If you are new to the Direct Payment Plan, please skip over this form and continue down the page to the Direct Payment Plan section.

Name

First Name

Last Name

Email Address

Checkbox

Use my banking information from the previous dance year for the Direct Payment Plan

I would like to update my banking information for the Direct Payment Plan (proceed to form below)

Direct Payment Plan

Here's how the Direct Payment Plan works:

You authorize regularly scheduled payments to be made from your checking or savings account. Then, just sit back and relax. Your payments will be made automatically on the specified day, and proof of payment will appear with your statement in addition to an e-mail receipt from the studio.

The authority you give to charge your account will remain in effect until you notify us via e-mail to terminate the authorization. If the amount of your payment changes, we will notify you before payment date.

Complete the authorization form below.

If you prefer to fill out a printable version of this document to turn in at Core Dance Center, click here.

Authorization for Direct Payment

I authorize Core Dance Center and the financial institution named below to initiate entries to my checking/savings account. This authority will remain in effect until I notify you in writing to cancel it in such time as to afford the financial institution a reasonable opportunity to act on it. I can stop payment of any entry by notifying my financial institution 3 days before my account is charged.

Name of Financial Institution

Branch

City, State, Zip Code

of Financial Institution

Electronic Signature

Please type first and last name of Account Holder.

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Dancer's Name

Please type dancer's first and last name.

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Account Number

Financial Institution Routing Number

Checking Account

Savings Account

On today's date, I authorize Core Dance Center of 217 1/2 N. Eastern Avenue (337-788-0223) to initiate electronic entries to my checking/savings account and have agreed to the terms listed on the authorization. I may revoke my authorization with the company at any time by emailing coredancecenter@gmail.com

I would like to Direct Pay on the 1st of each month.

I would like to Direct Pay on the 15th of each month.