Payee Name (required)
Today's Date (required)
Dancer Name (required)
Your Email (required)
I am paying for the following. Check all that apply.
You can also click "Other" and list your payment details in the box below.
Tuition (1 Month)Tuition (Multiple Months)Clogging ShoesRegistration FeeT-Shirt(s)TightsPrivate Lesson(s)Master SolosOutfitLate FeeComp. Registration FeesMerchandiseOther
If you checked "Other" above, please tell us what you are paying for in the below box
I would like to setup for reoccurring Tuition payment via credit card.
Your credit card will be charged on the 1st day of each month for your tuition.
Please charge me monthly for the next 06121824 months for tuition.
Total $ Amount to be Charged to my Credit Card:
A $2.50 processing fee will be applied to this transaction.
I Agree - Yes, I agree to pay the additional $2.50 processing fee which will be added to the total amount billed to my credit card.
I have a credit card on file that I would like you to use?
If NO, contact PowerTaps to provide your credit card number.
Credit Card Verification #
I agree to pay the above amount, plus the $2.50 processing fee via credit card to PowerTaps. I also confirm that the below information provided is correct and belongs to me.