ePayment Registration

Enter Billing Contact Info and Choose Basic Option OR Premium Option
 Billing Contact

   This is an update to my account info.

Name of Billing Contact:
Email of Billing Contact:
Billing Address:
Suite/Apt:
City:
Zip:
Name of student(s) taking lessons:
 Basic Option: Bank Account (No Fees)
Name on Account:
Name of Bank:
Routing #:
Account #:
 Premium Option: Credt/Debit Card (3% convenience fee will apply)
We Accept Visa, Master Card, and American Express only.
Name on Card:
Credit Card Number:
Expiry Date: /
CVV#:
 Terms of Agreement

   I have read and agree to the terms below.

Providence Music Academy will debit tuition charges, fees, supplies, and applicable service fees to the bank or credit/debit card account listed on this form. Monthly invoices will be sent to the email account on record at least five(5) business days prior to any debit. Charges will be debited on the due date for the amount due listed on the invoice. This authorization shall remain in force until written notice is given to withdraw from PMA. Returns for insufficient funds or credit declines will result in a $25 fee.



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