STORE YOUR INFORMATIONIN THE BACHATA VYBE PAYMENT SYSTEM! Are you signing up as a LEAD or a FOLLOW? * LEAD FOLLOW YOUR CONTACT INFORMATION Name * First Name Last Name Email * Phone * (###) ### #### CARD INFORMATION Cardholder Name * Card Number * Expiration * CVV * Zip Code * * I fully authorize Bachata Vybe (Tropik Vybe Dance Company) to charge my credit/debit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account. VIRTUAL SIGNATURE *