electronic studio waiver - WaiverElectronic

STUDIO 4 ATHLETICS FREEZE REQUEST FORM

I wish to request a temporary freeze (90 day maximum) of my Lifestyle Membership Agreement with Studio 4 Athletics Inc.

Name: * Please enter your name.

Date Submitted: *

Please enter valid date.

Phone: * Please enter your phone number.

Email: * Please enter your email.

Billing Date: *

Please enter valid date.

Method of Payment:

Credit Card

EFT

Please select at least one choice above.

Freeze Start Date: *

Please enter valid date.

Initial Here

I confirm the last payment date above * Please click the yellow area and provide your initials here.

Freeze End Date: *

Please enter valid date.

Initial Here

I confirm the freeze end date above * Please click the yellow area and provide your initials here.

I understand that I am required to give 30 days notice from the next scheduled payment withdraw date, as per the Membership Agreement, and that any overdue fees owed to the club must be paid in full before a freeze request can be processed. I understand that I must provide a thaw date to re-instate my membership not more than 3 months from the freeze date.

Member Signature: *

Click to sign

Please sign here.

Staff Member: *

Click to sign

Please sign here.

Business owners can sign waivers with customers without face to face.

STUDIO 4 ATHLETICS FREEZE REQUEST FORM