Payne's Gym: INDIVDUAL 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?

Emergency Contact

Name

Phone

Birth Date

Gender

Male Female Other

Source

Monthly 3rd Payment

$64.94

Amount Due Today

$191.74

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Startup Fee	$99.00	$0.00	$0.00	0
Membership Dues	$0.00	$59.99	$0.00	0
Prorated Dues	$67.20			0
Key Fob	$20.00	$0.00	$0.00	0
Sub-Total	$186.20	$59.99
Tax	$5.54	$4.95
Total	$191.74	$64.94

First Monthly 3rd Payment Date: 8/3/2022

Payments will then be processed on a Monthly 3rd basis there after.

Other Fee Information

Annual Upkeep Fee (Per member) of $40.00 will be billed on a Annual basis starting 1/17/2023

Payment Info

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Payne's Gym: INDIVDUAL Month to Month

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

Monthly 3rd Payment

Amount Due Today

First Monthly 3rd Payment Date: 8/3/2022

Other Fee Information

Payment Info

Payment Info

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