FITNESS 19 TX 177: Online Only-One Club

This plan requires 1 member with a maximum of 10 members.

How many total members would you like on this plan?

* This plan requires a minimum number of members including the primary member.

(1) 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

Gender

Male Female Other

Source

MONTHLY Payment

$10.83

Amount Due Today

$113.24

Service	Down Payment	Recurring	Rollover	Visits
Member 1
3. First Month Dues**	$0.00	$0.00	$0.00	0
4. Last Month Dues	$0.00	$0.00	$0.00	0
2. Dues Lock In Fee*	$0.00	$0.00	$0.00	0
Fitness Assesment	$0.00	$0.00	$0.00	1
Dues Lock In Fee	$0.00	$0.00	$0.00	0
General Facility	$0.00	$10.00	$0.00	0
General Facility	$5.61			0
1. Joining Fee	$99.00	$0.00	$0.00	0
Sub-Total	$104.61	$10.00
Tax	$8.63	$0.83
Total	$113.24	$10.83

First MONTHLY Payment Date: 5/15/2024

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

Other Fee Information

Annual Fee (Per member) of $39.00 will be billed on a Annual Fees basis starting 3/15/2025

Payment Info

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FITNESS 19 TX 177: Online Only-One Club

This plan requires 1 member with a maximum of 10 members.

MONTHLY Payment

Amount Due Today

First MONTHLY Payment Date: 5/15/2024

Other Fee Information

Payment Info

Payment Info

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