Template: 12-Month Agreement – T-Martin Fitness

Enrolled With(Required)

Name(Required)

First Last

Today's Date(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gender

Male
Female

Primary Phone

Cell Phone(Required)

Birthdate(Required)

Emergency Contact Name(Required)

Emergency Contact Number(Required)

Agreement Start Date(Required)

Agreement Expiration Date(Required)

Agreement Length(Required)

Number Of Sessions Per Month(Required)

Type Of Class(Required)

Semi-Private
Group Classes
Combo

First Time(Required)

Yes
No

Total Agreement Value(Required)

Enrollment Fee (Paid Today)(Required)

Please enter a number from 0 to 500.

Enter 0 if not applicable.

OR Discounted 12 Month Pre-Pay amount(Required)

Please enter a number from 0 to 5000.

Enter 0 if not applicable.

Remaining balance of $_____(Required)

Is To Be Paid In ____ Installments(Required)

Number of installments. Enter 0 if not applicable.

Of $____ Per Installment(Required)

Monthly Dues. Enter 0 if not applicable.

Which Will Be Billed On The ____ Of Each Month

Numerical Day Of The Month. Enter 0 if not applicable.

Starting On ____

MM/DD/YYYY (One Month From Today’s Date). Enter 0 if not applicable.

Last Payment Will Be On ____

MM/DD/YYYY (One Year From Today’s Date). Enter 0 if not applicable.

You Will Make A Total Of ____ Payments(Required)

Enter 0 if not applicable.

The First Month You Will Have ____ Training Sessions(Required)

Enter 0 if not applicable.

Leaving You ____ Training Sessions On Your Last Month

Session Expiration Date(Required)

MM/DD/YYYY (One Month After Agreement Expiration).

NOTES

Type in any specific notes that pertain to Agreement terms here. This WILL be displayed on the Agreement to be signed.

Card Type(Required)

Visa
Mastercard

Credit Card(Required)

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