Payment Test

"*" indicates required fields

Account Holder Name*

First Last

Email*

Phone*

Number of Payments Being Made*

Comments

Have over 6 instruments to pay towards? Please submit the form below with up to 6 instruments and start again to process additional payments, or give us a call at 1-800-52-MUSIC!

Student 1 Name*

Student 1 Instrument*

Student 1 Payment Type*

Student 1 Payment Amount*

Student 2 Name*

Student 2 Instrument*

Student 2 Payment Type*

Student 2 Payment Amount*

Student 3 Name*

Student 3 Instrument*

Student 3 Payment Type*

Student 3 Payment Amount*

Student 4 Name*

Student 4 Instrument*

Student 4 Payment Type*

Student 4 Payment Amount*

Student 5 Name*

Student 5 Instrument*

Student 5 Payment Type*

Student 5 Payment Amount*

Student 6 Name*

Student 6 Instrument*

Student 6 Payment Type*

Student 6 Payment Amount*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Credit Card

Please do not insert dashes in the credit card number.

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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1-800-52-MUSIC

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