5364 State Hwy. 51 West Burlington, NY 13482 607-376-7876
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Autopay Signup Request Form

Autopay can be used by our Dancing Families who choose to have their account charged on a monthly basis. This is only to be used for monthly tuition payments. All other payments, such as costumes or dancewear, can be charged to your account upon request.

Step 1: Primary Student Account Information

Contact Email:*
First/Last Name:*

Step 2: Billing Information

Name on Credit Card:*
Billing Address:*
City, State, Zip:*

Step 3: Payment Information

Card Number:*
Expiration Date:* / MM/YY
CVV/CV2 Number:*

By signing up for Autopay, I am allowing Otsego School of Dance and Performing Arts to charge my credit card for dance class monthly tuition only. Charges will be applied on the 1st of every month during the dance season in which student is registered. I understand that at any time I choose I can cancel my subscription to Autopay and my card will no longer be charged on a monthly basis.

I agree*

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