Ajax: Full Access No Commitment

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

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Emergency Contact

Name

Phone

Birth Date

Add-Ons for this member

WFCC Connect

$0.00 down $5.00 / every 2 weeks

Bi-Weekly Payment

$33.84

Amount Due Today

$79.78

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Program Orientation #1	$0.00	$0.00	$0.00	1
Consult	$0.00	$0.00	$0.00	1
Unlimited Classes	$0.00	$0.00	$0.00	0
General Facility	$0.00	$29.95	$29.95	0
General Facility	$10.70			0
Last Month Deposit	$59.90	$0.00	$0.00	0
Sub-Total	$70.60	$29.95
Tax	$9.18	$3.89
Total	$79.78	$33.84

First Bi-Weekly Payment Date: 5/9/2024

Payments will then be processed on a Bi-Weekly basis there after.

Other Fee Information

Admin Fee (Total) of $35.00 will be billed on a Annual basis starting 6/3/2024

Payment Info

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Ajax: Full Access No Commitment

This plan requires 1 member with a maximum of 1 members.

Bi-Weekly Payment

Amount Due Today

First Bi-Weekly Payment Date: 5/9/2024

Other Fee Information

Payment Info

Payment Info

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