Twinkle Toes Ballerina II Enrollment


Order Information


Company name:  
Customer ID:
  New
First name*:   Last name*:
Phone:   Alt phone:
Email:   Alt email:
Student First/Last Name*:
Student Date of Birth*:
Preschool/School Name*:
Mailing Adresss, & Zip*:
Parent Occupation*:
How did you hear about us?*:
Twinkle Toes Ballerina II Class Selection*:
Leotard Size*:
Tights *:
Slippers*:
I understands all auto payments are due on the 1st of each month.*:
I understand if payments are not received by the 4th a $25 late fee is assessed on accounts*:
I understand a 15 day business notice is mandatory for program cancellation. TERMS page on website*:
I have read and agreed to Dazzle's Terms and Conditions*:

Payment Information


Invoice number:
Payment amount:
Recurs:
Payment date:

Choose Payment Type:

Credit card accounts (optional)
Card type*:
Card number*:
CVV2 Code*:
Expiration date*:
What's This?
Set as default account:
Credit Card
Credit Card

Billing Address


Address 1*:
Address 2:
City*:
State/Province*:
Country*:
ZIP/Postal Code*: Help


Create Account


Make repeat transactions fast and easy, enter a user ID and password to create an account and save your information in our secure system.
User ID:  
Password:  
Re-enter password:    

Terms and Conditions





Dazzle Creative Dance and Movement
3729 S. Hickory Ridge Mall
Suite 480
MEMPHIS, TN 38115
(901) 300-0547
dazzledancememphis@yahoo.com
http://www.dazzlecreativedance.com

By enrolling or making a payment in PaySimple, you agree to the Buyer Terms and Conditions