Wilson's On Rangeline: 12. Rangeline Monthly

Primary Member Information

First Name

M.I.

Last Name

Address 1

Address 2

City

State / Province

Zip / Postal Code

Home Phone

Mobile Phone

OK to Contact Home Phone

OK to Contact Mobile Phone

Preferred Phone

Home

Mobile

OK to Contact Email?

Birth Date

Source

Add-Ons for this member

Class Pass

$0.00 down $35.00 / month

PT MAP Move Assess Plan

$149.00 down $0.00 / month

PT Boost

$49.00 down $0.00 / month

Monthly Payment

$53.93

$78.78

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Capital Improvement Fee	$50.00	$0.00	$0.00	0
Capital Improvement Fee	$11.48			0
Rangeline EFT	$0.00	$49.95	$0.00	0
Rangeline EFT	$11.48			0
Sub-Total	$72.96	$49.95
Tax	$5.82	$3.98
Total	$78.78	$53.93

Payments will then be processed on a Monthly basis there after.

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