Credit Card Authorization Form

Please complete all fields below. You may cancel this authorization at any time by contacting Ramos Piano Studio. This authorization will remain in effect until cancelled. Once you have completed this form, please click the Submit button below.

Credit Card Information

Credit Cards Accepted: MasterCard, VISA, Discover, AMEX

* Indicates required field

Student Name(s) *

Cardholder's Name *

Card Number *

Expiration Date (mm/yy) *

Cardholder ZIP Code (from Credit Card billing address) *

Security Code *

I authorize Ramos Piano Studio to charge my credit card for agreed upon charges. I understand that my information will be saved to file for future transactions on my account. *

Yes No

Once you have completed this form, please click the Submit button below:

Submit