EmailMeForm
Autopay Payment Update
Please use this form to provide an updated credit or debit card for your existing payment plan.
** Did you just order/receive your rental instrument? No need to fill out this form, you are all set. No further action is needed. **
Adult Name
*
First
Last
This should be the adult name on your Rental Account
Billing Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Please enter the address that is on file with the card.
Cardholder Phone Number
*
###
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###
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####
Email
*
This will be used for future receipts
Confirm
Account Number(s) if known
Your account number a 5 digit number that may appear on receipts
Please Choose:
*
I am on Autopay, and need to update my card information
Please enroll me in Autopay with the card provided below
If payment is due, the card provided will be used to charge all payments due.
Payment Details
Please provide payment details below
Accepted Payments: Visa, Mastercard, Discover, American Express
Credit Card
*
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
Protected in vault
Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Autopay Authorization
*
I do authorize
As named Cardholder; I Authorize: ***David French Music*** to charge my card each month for rental payments. I understand that this payment will continue until I own the instrument, cancel my rental agreement with DFMC, or contact DFMC to discontinue Autopay.
Signature
*
Clear
Use the mouse or your touchscreen to sign
