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Auto-Pay Authorization

Credit/ Debit
I authorize Make Music with Daddy's℠ to charge $__________________ to my credit card monthly.

Card type (circle one) VISA MC Discover Debit

Credit card
number______________________________________________________________________

Expiration Date_______________________________Security Code______________________

Name (as appears on credit card)__________________________________________________

Address______________________________________________________________________

City________________________________________State______________Zip_____________

Phone______________________________________Email_____________________________

Signature________________________________________________Date_________________

Charge will appear as Band Gig™ Music Program on your statement.

444 Providence Hwy Dedham, MA 02026 (781) 85-MUSIC makemusicwithdaddysdedham.com

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