Change in Registration - Encore Ballroom Couture Encore Ballroom Couture

New Or Existing Customer?*

New customers you'll need to register before you can proceed. We require your address and billing information be on file and up to date. Existing customers as long as nothing has changed you can proceed.

New Customer

Existing Customer

Contact Information

Name*

First Last

Email*

Preferred Number*

Home

Work

Cell

Home Phone*

Work Phone*

Cell Phone*

Do you have a second phone?*

No

Yes

If we can't reach you at your preferred number

Second Phone Number*

Billing Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please Choose One*

Shipping Information same as Billing

Add Shipping Information

Shipping Information

In the event we would need to ship your dress back to you, please provide a shipping address where the package can be delivered during business hours with direct signature required. We use FedEx as our shipping company of choice. Please note, FedEx does not deliver to P.O. Boxes. We will email the tracking number once shipped.

Name*

First Last

FedEx Account #

Company

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Noted Changes

List All Changes Made*

Receiving Payment

Please Choose*

U.S. Resident
I am happy to receive payment in the form of a company check to my Billing Address

International Resident
I must receive payment through an international bank wire transfer

International Bank Payment

If you have selected to receive your payment by International Bank Wire Transfer, please note there is a $50 wire transfer fee, which will be deducted from your rental commission and there is a $75 wire transfer fee, which will deducted from your purchase commission. If you need to update your bank account information, please call the studio directly at +1 (703) 573-1640.

Terms & Conditions

This contract is strictly for the purpose of updating your registration information. By clicking submit, you agree to all Terms and Conditions set forth in this Change in Registration Information Contract. You verify that you are of legal age (18 years or older). You certify that you are authorized to use the credit card provided. Your credit card will never be charged without your authorization.

Comments

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