Payment Form — The Acting Project

Credit Card - Tuition Payment Form

Student's Name

First Name

Last Name

Name on Credit Card

First Name

Last Name

Email of Card Holder

Phone Of Card Holder

(###)

###

####

Credit Card Number

Expiration Date ( Example 03/22)

3 Digit Code on Back

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

WHAT WILL BE CHARGED: The fee for new students taking classes is $165 per month. There is also a one time $30 production fee. Your Credit Card will be charged $195 for the first month for our new students (returning students will be set at what was discussed.) Your card will automatically be charged $165 every month after that around the same date your first payment went through. You can cancel at any time by sending in a written notice within 15 days of the next payment processing date. Please initial below that you have read this.

Card Holder's Initials