Agreement
Agreement
Gamboa Odir
Name: ___________________________________________________________________________________________________________________________
Last First Middle
Bridgeport
City: _________________________________________________________________________ CT
State: ______________ 06606
Zip: ____________________________
(203) 673-5483
Primary Telephone: ________________________________ (203) 673-5483
Mobile Telephone: ________________________________
[email protected]
Email: __________________________________________________________________________________________
Promissory Note
For the value received I promise to pay _____________
12 consecutive monthly dues of $______________,
$ 26.58 due on or about the _____________
26
day of each month beginning _____________________.
03/26/2024
I understand that after ________
12 membership will
payments my membership rate will increase to $_______________
31.89 a month. My
automatically continue for successive 30 day periods until written notice of termination
of said agreement is received by ABC Fitness Solutions, LLC. I understand that I must give 30 days
written notice prior to the charge date of the month I wish to discontinue. Written notice must be mailed by certified mail to ABC Fitness Solutions,
LLC, PO Box 6800, Sherwood, AR 72124 or emailed to [email protected].
I promise to pay an annual club maintenance fee of $___________
53.16 on or about every ______________.
04/01
Promissory Note Signature: ________________________________________________
The member’s promissory note may be discounted or sold to third parties to whom the member will be obligated to make a full payment.
I recognize my responsibility to ensure that I/my minor child participates only in those activities for which I/he/she has the required skills, qualifications, training and physical condition-
ing. To the best of my knowledge, I do not/my minor child does not have any physical limitations that would prevent me/him/her from participating in the said program. I understand and
acknowledge that I am fully aware of and assume the risks (including but not limited to the risk of serious bodily injury) of my/said minor child’s participation in the program. Knowing the
risks described above, I agree, personally/and on behalf of my minor child to assume all risks and responsibilities relating to my/my minor child’s use of any and all apparatus, appliance,
facility, facilities privilege or service whatsoever, owned and operated by this club at my/ my minor child’s own risk and to the extent allowed by law shall hold this club, its shareholders,
directors, officers, employee, representatives, and agents harmless from any and all loss, claim, injury, damage or liability sustained or incurred by me/my minor child while on the club’s
premises, including those caused by the club’s own negligence. I have read the above and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
_________
Club Representative __________________________________________________ Member or Guardian Signature: _________________________________________________
DEFAULT AND LATE PAYMENTS: Should you default on any payment obligation as called for in this agreement, the club will have the right
to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not
limited to collection agency fees, court costs, and attorney fees. A default occurs when any payment due under this agreement is more than ten
days late. A SERVICE FEE WILL BE CHARGED IMMEDIATELY FOR ANY CHECK, DRAFT, CREDIT CARD, OR ORDER RETURNED
FOR INSUFFICIENT FUNDS OR ANY OTHER REASON. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN TEN DAYS
PAST DUE, YOU WILL BE CHARGED A LATE FEE. If the Member is paying monthly dues by electronic funds transfer (EFT), the club’s bill-
ing company, ABC Fitness Solutions, LLC, reserves the right to draft via EFT all amounts owed by the member including any and all late fees
and service fees. Subject to appropriate State and Federal Law. NOTE: Members paying monthly dues by E.F.T. are subject to $5.00 per
month increase of monthly dues if E.F.T. payment is stopped or changed. This will not affect any other provisions of this agreement.
If you provide us with more than one form of payment, you authorize us to charge any amounts you may owe, including but not limited to any
membership-related obligations, retail transactions, and/or online purchases, to any Edge Fitness facility to any form of payment with which you
have provided us until such time as you revoke your authorization for that form of payment by written notification delivered to the club in person
or postmarked via certified mail, or by notifying your financial institution.
PLEASE ATTACH A VOID OR BLANK CHECK
REQUEST FOR PREAUTHORIZED PAYMENT
I/We hereby request the privilege of paying to ABC Fitness Solutions, LLC (“The Company”), Sherwood, AR 72124, and further authorize the Company to draw items (checks, electronic
fund transfers, charge card) for the purpose of paying said payments, including any late fees or service fees, on the account of
A VOIDED OR BLANK CHECK MUST BE ATTACHED
PRIMARY PAYMENT ACCOUNT *ALTERNATIVE PAYMENT ACCOUNT
Odir Gamboa
NAME ON ACCOUNT: ____________________________________________________ NAME ON ACCOUNT: ____________________________________________________
JPMORGAN CHASE BANK XXXXX8081
BANK/CREDIT CARD #: _________________________________________________ BANK/CREDIT CARD #: __________________________________________________
021100361
ROUTING #: ______________________________ EXPIRATION DATE: ____________ ROUTING #: ______________________________ EXPIRATION DATE: ____________
Subject to the following conditions:
(1) The items outlined in Your Membership Agreement (monthly dues, annual fees, enrollment fees, etc.) shall be drawn on or about the date or dates set (8) By executing this Agreement, You authorize Club and Club’s agents, including its third party payment processing companies (“Club’s Agents”), to store
forth in the Membership Agreement. By signing below, You authorize the Company to draft via EFT said amounts from the account or card identified herein. the account or card information provided by You on or in relation to this Agreement and/or Your Club Membership Agreement (“Club Agreement”), as well as
The transactions on Your bank, debit, or credit card statement shall constitute receipts for payment on Your account. any other account or card information provided by You through any means to Club or Club’s Agents (including information provided in person, online or over
(2) One-Time Transfers: When You provide a check as payment, You authorize the Company either to use information from Your check to make a one-time the phone) for purposes of making any payment in relation to this Agreement and/or Your Club Agreement (hereinafter, “Payment Information”). Club and/or
EFT from Your account or to process the payment as a check transaction. When the Company uses information from Your check to make an electronic fund Club’s Agents will use the stored Payment Information to process payment of all dues, fees, taxes, purchases and incidental charges that are due or will be-
transfer, funds may be withdrawn from Your account as soon as today’s date. come due, including all items on the Payment Schedule, fees identified in Your Club Agreement, membership-related obligations, retail transactions, personal
(3) If the regular payments set forth in the Membership Agreement should vary in amount, You are entitled to notice at least 10 days before each payment of training purchases, group exercise purchases, childcare fees, or other purchases. Club and/or Club’s Agents may also use the stored Payment Information
when it will be made and how much it will be. However, by executing this preauthorization, You choose to instead get this notice only when the payment would to process payments owed in relation to all subsequent Agreements entered between You and Club. The fixed dates or intervals on which transactions will
differ by more than $50.00 from the most recent payment You have made. be processed and the transaction amounts (including all associated fees, taxes, and charges) and/or a description of how they will be calculated are more
(4) By executing this Agreement, You acknowledge Your awareness that certain disclosures required by the Electronic Funds Transfer Act and its regulations specifically set forth in the Payment Schedule and other terms of Your Club Agreement. If Your Club Agreement will automatically renew at the end of the
are available for Your review at the Company’s website: www.abcfitness.com under Terms of Service. Term defined therein, the stored Payment Information will be used to process payments owed in relation to the renewal term. This consent to store Payment
(5) The privilege of making EFT payments under this arrangement may be revoked by the Company if any item is not paid upon presentation. Information will not expire unless it is expressly revoked. The general cancellation and refund policies provided in Your Club Agreement will apply to this
(6) If this preauthorization payment arrangement is revoked for any reason, this does not release You from Your obligation under Your Membership Agree- consent. If any changes are made to the terms of this consent, an e-mail notifying You of such changes will be sent to the e-mail address provided by You on
ment. the face of Your Club Agreement or, if an e-mail is not provided, notice will be sent to the mailing address provided on Your Club Agreement.
(7) If any payment is not paid upon presentation to Your bank or credit/debit card company for any reason, a service fee will be assessed and drafted. A late (9) This preauthorization payment arrangement shall apply to the following Applicant(s):
fee will be assessed and drafted should any monthly payment become past due.
Monthly Dues Paid By Monthly Dues Paid by Annual 12 Month Paid In Full
Enrollment Fee Processing Fee EFT from Bank Account Credit Card/Debit Card Maintenance Fee Contracts