Make a payment to the DABH.  Charge my credit card this amount  >> 

Any questions please call the DABH at 248-335-2585
Please Fill out this form completely and then click "Submit Form" button at bottom of this page.
 
Student's First Name        Student's Last Name
Credit Card Billing Address   City     Zip Code
Exact Name on Credit Card as it appears

Payment information below
  Account Number  

Please update my account to AUTOPAY
<< Check this box for AutoPay with my credit card - MONTHLY
 << Check this box for AutoPay with my credit card - SESSION
 

Optional below unless we don't have this information in the system at the studio
Home Phone      eMail Address
Mother's Name Work Number Cell Phone
Father's Name  Work Number Cell Phone
 

Any other notes or information, requests you want to attach to this payment submission below