Client Application and Purchase Agreement Form

LAST NAME _________________________       

 FIRST NAME _________________________

AGE ___________________            TELEPHONE # __________________________

ADDRESS___________________________________       

CITY, STATE, ZIP ____________________________________

EMERGENCY CONTACT

(Name)____________________________

(Phone #)__________________________

PURCHASE/MEMBERSHIP AGREEMENT AND CONDITIONS OF USE

Membership Packages:

• Automatic Renewal: Contract is in force from Contract Start Date, with automatic renewal for subsequent months, unless cancelled by either the member or Brittnee Ann Fitness LLC, with notification IN WRITING.     Initial_______
• Cancellation Form: Cancellation requires 1-month notice/1-month final pay.  To cancel membership, notification is required IN WRITING.  Once the cancellation form is submitted, the client will remain a member for 1 month following (if billing period falls within this 1 month – client agrees to make payment and will be an active member until the end of that billing cycle).  Client cannot cancel membership the first week of signing up.  Therefore, client must remain a member for 2 months minimum.       Initial_______
• Purchase/Payment Agreement to Recurring Fees: The member agrees to pay Brittnee Ann Fitness LLC monthly recurring fees as follows:  Membership Package including _______ Sessions per month for $___________ via client automatic payment method (either credit card or bank account (ACH)).     Initial_______
• The full membership fee as above is payable weather or not the member makes full use of their package sessions. Sessions expire at the end of each month/billing period.  Sessions do not roll over.  Any unused sessions are considered lost/forfeited. The membership fee or any part thereof is non-refundable or non-transferable.  There are no refunds.  All sales are final.     Initial_______
• The member agrees to observe the rules designed for the mutual benefit of all members.  In the event a member repeatedly disregards the rules his/her membership will be terminated without refund.  The member agrees that he/she is over 18 years of age and that having understood the terms of agreement, agrees to abide by them.       Initial_______

Individual and Group Packages (includes online challenge group training):

• Individual and Group Package Agreement: The client agrees to pay Brittnee Ann Fitness LLC payment for the individual and/or group package(s)/session(s).  The client agrees to continue to pay Brittnee Ann Fitness LLC on time for any future packages/sessions purchased.  The payment or any part thereof is non-refundable or non-transferable.  There are no refunds.  All sales are final.          Initial_______
• The client agrees to observe the rules designed for the mutual benefit of all members/clients.  In the event a client repeatedly disregards the rules his/her membership/package/sessions will be terminated without refund.  The client agrees that he/she is over 18 years of age and that having understood the terms of agreement, agrees to abide by them.       Initial_______

Membership Packages: Please read and sign below. 

• I agree to purchase the Membership Package including _______ Sessions per month for $_________, as an automatic charge to my credit card/bank account (ACH) each month.     Initial_______

Individual and Group Packages (includes online challenge group training): Please read and sign below.

• I agree to purchase the individual and/or group package/session(s).  I agree to continue to pay Brittnee Ann Fitness LLC on time for any future packages/sessions purchased. Initial_______

All Clients:

• I hereby certify that I am the holder of the credit card/owner of the bank account (ACH)   Initial_______
• I understand that I will be notified if my payment fails to authorize for any reason, and a returned check fee of $30 will be charged to my account for any insufficient funds.  I understand that a $20 late fee will also apply if I do not provide a valid form of payment within 10 calendar days of the original rejection date.      Initial_______
• I understand that my service will be deactivated if my account becomes delinquent/has failed payment.  I understand that my account will be reactivated once a valid payment is made and accepted and late fee is paid.    Initial_______
• I plan to join/participate in Brittnee Ann Fitness LLC services and agree to and will observe the rules and regulations that are on the premises.     Initial_______
• I have read and agree to all Terms and Conditions (found on the Terms and Conditions document – if you have not signed this document, please ask Brittnee Ann Fitness LLC for a copy) and will be held accountable for all terms and conditions listed for all services purchased.  Initial_______
• I hereby certify that I have read all Membership, Individual, and Group conditions and agree that if in the future I decide to switch packages/purchase a different package option, I agree to all conditions listed for current and future packages (including membership, individual, and group).  This document and my signature are to be considered my consent to all conditions for all agreements listed above.  Initial_______

*First Payment withdrawal will be _$__________[Pro-rated or Full Month’s payment] on ____________ *Following the first payment, automatic renewal/recurring payments will occur the __________ of every month.   Bank Account Information:   Account # __________________________________________ Routing #___________________________________________ Credit Card Information:   Credit Card #_____________________________________   Exp Date ____________________   CVV/CVD#______________   Zip Code for Card_____________________

SIGNATURE _________________________________  DATE __________________