Parisi at the MAC: 14. Classes Month to Month

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

Forum Towel Service

$0.00 down $15.00 / month

PT MAP Move Assess Plan

$149.00 down $0.00 / month

PT Boost

$49.00 down $0.00 / month

Monthly 7th Payment

$97.12

$103.35

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Capital Improvement Fee	$75.00	$0.00	$0.00	0
Service Fee	$0.00	$0.00	$0.00	0
Classes EFT	$0.00	$89.95	$0.00	0
Classes EFT	$20.72			0
Sub-Total	$95.72	$89.95
Tax	$7.63	$7.17
Total	$103.35	$97.12

Payments will then be processed on a Monthly 7th basis there after.

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