Client Information Form | Matt Lombardi Music

CLIENT INFORMATION FORM

Official form for new clients or existing client updates. All information provided will be held on file with Matt Lombardi Music and will not be shared or used for any extended advertising or marketing purposes; should any details change, please get in touch to fill out a new form.

TODAY'S DATE

POINT OF CONTACT FIRST & LAST NAME

EMAIL ADDRESS

PHONE

MAILING ADDRESS

NAMES OF ALL MEMBERS IN YOUR HOUSEHOLD

CREDIT CARD INFORMATION & AUTHORIZATION

In the space provided below, please include the following information from your card:

name on card, card number, expiration date, security code, and billing address if different from one listed above.

The card listed below will be the one your lessons are held with and used to fulfill lesson payments upon request or should lesson payments be unfulfilled prior to the end of the lesson; no-show fees will be automatically charged to this card.

CREDIT CARD AGREEMENT

THE CLIENT(S) authorize(s) Matthew Lombardi to charge the credit card included in this form for agreed upon purchases of service transactions, including but not limited to completed services and the aforementioned no-show policies. Included in all online transactions is a 4% fee on behalf of the processing company, which THE CLIENT(S) will assume in payment(s). THE CLIENT(S) understand(s) that the included credit card information will be saved to file for future transactions on my account.

Thanks for getting in touch!

CC INFORMATION

I AGREE TO THE TERMS & CONDITIONS

Your Signature