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Payment Authorization Form

If you want to update your payment on record, please fill out the below Recurring Payment Authorization Form.

JM Dance Center Recurring Payment Authorization Form

Student's Name School Name

Schedule your payment to be automatically deducted from your debit or credit card. Just complete and sign this form to get started! Cash or check will not be accepted. All payments must be automatic from your debit/credit card.

Here's How Recurring Payments Work:

You authorize regularly scheduled charges to your debit/credit card from the 1st to the 5th of each month. You will be charged the amount indicated below each billing period. All monthly payments for classes must be made from the 1st to the 5th day of each month.
Once you enroll for the program you will be charged each month starting from the current month until you cancel by email. We have classes during school year and Summer. If the student will not participate in summer, you must cancel in advance.
Cancellation must be directly to jmdancecenter@gmail.com via email at least 10 days before your scheduled withdrawal date. Cancellations will not be processed via text /message / phone call / nor at school / or with instructor. ONLY VIA EMAIL. Your cancellation email must contain full student and school name and the month you would like to cancel and/or if you would like to recess for that month & continue enrollment on the following month. No refund will be provided if the academy has not received a previous cancellation email 10 days before the due date / No credits or refund if class is missed due to National holidays/ Winter Break /or if student is absent from class.
In the case of an ACH Transaction being rejected for Nonsufficient Funds (NSF) or change in card information, I understand that JM Dance Center may, at its discretion, attempt to process the charge again within 30 days and I agree to pay an additional Fee charge for each attempt returned NSF, which will be initiated as a separate transaction from the authorized recurring payment.
You must notify in writing of any changes in your card/bank account information to avoid declined transactions. You will need to provide a new withdraw authorization form with the updated card information. If your payment cannot be processed due to a change in information without previous notice, you will be charged an additional fee of $25.00.
Any dance class canceled by the school or due to Holidays will not be rescheduled by the company, and no further discounts or refunds will be given.
Full payment must be made in the month of June if the student participates in the school's end of the year graduation.
JM Dance Center reserves the right to withdraw any student from ballet classes after one month without payment.
JM Dance Center uniform is required. The first month you will be charged an additional $85.00 plus taxes to cover the cost of the uniform. JMDC uniform includes a black leotard with the company logo, a black ballet skirt, one pair of ballet slipper and pink stockings.

Please complete the information below:

I, authorize JM Dance Center to charge my credit/debit card
indicated below for $ in the of each Month for payment of my Dance Classes.
I, authorize JM Dance Center to charge my credit/debit card.
indicated below for $ only for the first month (this amount includes first month & registration fee)

Cardholder Name:

Card Number:

Exp Date: / CCV

Phone Number

Email

I, understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify JM Dance Center in writing of any changes in my account information or termination of this authorization at least 10 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that JM Dance Center may at its discretion attempt to process the charge again within 30 days and agree to an additional Fee charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company, so long as the transactions correspond to the terms indicated in this authorization form.

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Signed by Jeniffer Munives
Signed On: March 2, 2023

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March 2, 2023 6:32 pm EDT

Payment Authorization Form Uploaded by Jeniffer Munives - jmdancecenter@gmail.com IP 73.245.47.91, 66.248.201.6, 132.148.110.2, 0.0.0.0, 73.245.47.91