Application (Recurring Lessons)

Country

Billing ZIP

Parent/Guardian Phone

Mailing Zip *

Card Number *

Card Expriation Month *

Billing Address (Include Apt/Ste No)

AUTOMATIC BILLING INFORMATION (Is the mailing and billing address the same?) *

Yes - Proceed to the Study Options section.

No - Complete the address information then proceed to the Study Options section.

Cardholder Phone *

Student Date of Birth *

Student Phone *

Parent/Guardian Name

Billing City

Card Expriation Year *

Application & Contract (Recurring Lessons)

Before you complete the application, be sure to read the Terms and Conditions. If you have questions about the Terms and Conditions or the Application below, please feel free to call (972) 629-9007.

Payment Frequency *

Mailing City *

Mailing State *

Student Full Name *

Parent/Guardian Email

Study Options (Automatic Billing Setup Required) *

CVV *

STUDENT INFORMATION (Is the Student a minor?) *

Yes - Complete the Student AND Parent/Guardian Information section.

No - Complete only the Student Information Section leave the Parent/Guardian Section blank.

Cardholder Name (Exactly as it appears on the credit/debit card) *

Student Email: *

Mailing Address (Include Apt/Ste No., if applicable) *

Card Type *

Visa

MasterCard

Discover

American Express

Cardholder Email *

Acknowledgement *

I authorize the Damon K. Clark Vocal Studio to make recurring charges to my Credit/Debit Card listed in this contract/recurring debit authorization form, and if necessary, to initiate adjustments for any transactions credited or debited in error. This authority will remain in effect until the Damon K. Clark Vocal Studio has received written notification from me to cancel it. If I wish to cancel this contract and recurring debit authorization, I understand after having read the Terms and Conditions, that notice of my intent to cancel this contract and recurring debit authorization must be submitted via the SUSPEND/CANCEL form on this website at least thirty (30) days in advance of your scheduled payment cycle (Automatic Billing date) which can be found in this contract. If the contract cancellation is not submitted at least thirty (30) days before the next scheduled Automatic Billing date, I am responsible for payment.

Choose an Automatic Billing Date *