Tuition Payment Form Signature
Tuition Payment Form
Please complete the following form to include each dancer within the family. If your family needs financial assistance, please complete the Financial Aid Request Form.
[ ] Financial Aid Requested
[ ] Financial Aid Approved _____% Financial Aid Received
STUDENT #1 Student Name: _________________________________ Phone: ________________________ Number of Classes: _________
STUDENT #2 Student Name: _________________________________ Phone: ________________________ Number of Classes: _________
STUDENT #3 Student Name: _________________________________ Phone: ________________________ Number of Classes: _________
Total Number of Classes: ______
[ ] Tuition Cap Met
[ ] Payment Arrangement
TOTAL SESSION FEES # of classes______ Tuition: $__________ Financial Aid: ________% Total Amount Due for Fall 2017 Session: $____________
PAYMENT INFORMATION Payment Amount: $____________ Payment Type: CASH (preferred) CHECK (preferred) VISA / MC / AMEX / DISCOVER Credit Card Owner:_______________________________ Phone: ________________________ Credit Card Number: __________________________________ Exp. __/____ CCV:______ Credit Card Billing Address:_________________________________________ Zip: __________ **Credit cards carry a 2% transaction fee**
I, the undersigned, authorize the Rivertown Dance Academy to accept my payment in the amount of $________ on ___/___/____ and agree to make additional payments agreed.
Signature _______________________________ Date________________ [for office use] Processed by:
[ ] Recorded
[ ] Paid in Full
[ ] Partial Pay
[ ] FA
[ ] on hold
[ ] Family
Please complete the following form to include each dancer within the family. If your family needs financial assistance, please complete the Financial Aid Request Form.
[ ] Financial Aid Requested
[ ] Financial Aid Approved _____% Financial Aid Received
STUDENT #1 Student Name: _________________________________ Phone: ________________________ Number of Classes: _________
STUDENT #2 Student Name: _________________________________ Phone: ________________________ Number of Classes: _________
STUDENT #3 Student Name: _________________________________ Phone: ________________________ Number of Classes: _________
Total Number of Classes: ______
[ ] Tuition Cap Met
[ ] Payment Arrangement
TOTAL SESSION FEES # of classes______ Tuition: $__________ Financial Aid: ________% Total Amount Due for Fall 2017 Session: $____________
PAYMENT INFORMATION Payment Amount: $____________ Payment Type: CASH (preferred) CHECK (preferred) VISA / MC / AMEX / DISCOVER Credit Card Owner:_______________________________ Phone: ________________________ Credit Card Number: __________________________________ Exp. __/____ CCV:______ Credit Card Billing Address:_________________________________________ Zip: __________ **Credit cards carry a 2% transaction fee**
I, the undersigned, authorize the Rivertown Dance Academy to accept my payment in the amount of $________ on ___/___/____ and agree to make additional payments agreed.
Signature _______________________________ Date________________ [for office use] Processed by:
[ ] Recorded
[ ] Paid in Full
[ ] Partial Pay
[ ] FA
[ ] on hold
[ ] Family
