Credit Card Payment Information

I authorize AWSOM to initiate recurring credit card charges starting on May 1st and on the 1st day of each month following until withdrawal from lessons for the amount indicated on each monthly invoice. This payment authorization is to remain in full force and effect until I notify AWSOM of its cancellation by submitting a withdrawal form [awsom.info/withdrawal] in such time and in such manner to allow both AWSOM and the receiving financial institution a reasonable opportunity to act on it. *

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Credit Card Number *

Expiration Date MM/YYYY *

Security Number *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *