Online Registration

I hereby authorize you to debit my account as identified above. This authorization shall remain in effect until the terms stated have been met or until Amanda’s Academy of Dance has received written notification from me of intent to terminate at such time and in such manner as to afford Amanda’s Academy of Dance and bank reasonable opportunity to act (minimum of 30 days). All other changes such as payment amount, frequency, bank account number change, will require a new Payment Authorization Form to be filled out and submitted to Amanda’s Academy of Dance 5 days prior to any change being implemented. I understand that this payment plan may be cancelled by Amanda’s Academy of Dance due to uncollectible funds. I will be liable to pay a fee for each returned check. I understand that if my electronic debit is returned to you for insufficient or “held” funds, it will be re-presented electronically and my account will be debited for the amount of the payment plus the state-allowed fee. I represent and warrant that I am authorized to execute this payment authorization for the purpose of implementing this payment plan. I indemnify and hold Amanda’s Academy of Dance the check processor, and the bank harmless from damage, loss, or claim resulting from all authorized actions hereunder.