Payment Method

_______________________________________________________ HOME PHONE (515) _________________________
LAST NAME (OF STUDENT HOUSEHOLD)

OPTION 1: PAY YEARLY
Pay total amount (9 months Tuition, Costumes, and any additional fees required for the classes enrolled) and we will waive the $47.00 Recital Fee.

OPTION 2: 8 POST-DATED CHECKS
To be written out for each month's Tuition (October-May) including Recital Fee in October, Costume Payment in December (check will be returned to you if costume paid prior to December 1st) and any additional fees
(if applicable) in January. PLEASE ALSO PROVIDE A BACK-UP CREDIT CARD.

FOR OFFICE USE: CHECK #'s _____________________________________________________________________________

OPTION 3: CREDIT CARD
Monthly deductions are made the first of each month for tuition (October-May) including Recital Fee in October, Costume payment in December (if not paid prior to December 1st) and additional Fees (if applicable) in January.

(please circle) MASTERCARD VISA

Name on account _______________________ Account number _______________________________ Exp._____

I/We authorize Norwalk Superstars, L.L.C. to receive automatic payment for my monthly/yearly bill. It is also agreed the credit card named above will debit my account.

Signature (account holder) _______________________________________________ Date __________________

OPTION 4: AUTO WITHDRAWAL FROM CHECKING
Monthly deductions are made the first of each month for tuition (October-May) including Recital Fee in October, Costume payment in December (if not paid prior to December 1st) and Additional Fees (if applicable) in January.

PLEASE ATTACH A VOIDED CHECK.

Name of Account Holder ________________________________ Financial Institution _______________________

Routing Number _________________________________ Account Number _______________________________
(9 digit number between symbols)
I/We authorize Norwalk Superstars, L.L.C. to receive automatic payment for my monthly bill. I/We also give the right of reversal to correct withdrawals. It is also agreed the financial institution named above will debit my account.

Signature (account holder) _______________________________________________ Date __________________