ZONE5 Fitness: Zone5 Month to Month

Number of People

Primary Member Information

First Name

M.I.

Last Name

Address

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

Source

Did anyone at the club assist you?

Add-Ons for this member

Quickstart POS

$99.00 down $0.00 / month

MONTHLY Payment

$69.00

Amount Due Today

$19.00

Service	Down Payment	Recurring	Rollover	Visits
Member 1
General Dues	$0.00	$69.00	$0.00	0
Initiation Fee	$19.00	$0.00	$0.00	0
Sub-Total	$19.00	$69.00
Tax	$0.00	$0.00
Total	$19.00	$69.00

First MONTHLY Payment Date: 1/1/2020

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

Other Fee Information

Annual Fee (Per member) of $25.00 will be billed on a ANNUAL basis starting 3/1/2020

ZONE5 Fitness: Zone5 Month to Month

Number of People

MONTHLY Payment

Amount Due Today

First MONTHLY Payment Date: 1/1/2020

Other Fee Information

Payment Info

Payment Info

ZONE5 Fitness: Zone5 Month to Month

Number of People

MONTHLY Payment

Amount Due Today

First MONTHLY Payment Date: 1/1/2020

Other Fee Information

Payment Info

Payment Info

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