Template: Short-Term Contract

Enrolled With*

Today's Date*

Email*

Primary Phone

Cell Phone*

Birthdate*

Emergency Contact Name*

Emergency Contact Number*

Contract Start Date*

Contract Length*

How Did You Hear About Us?*

Google, Facebook, Referral (Write Name Of Referral), Drive-By

Total Contract Value*

Enrollment Fee (Paid Today)*

OR Discounted 12 Month Pre-Pay amount*

Enter 0 if not applicable.

Remaining balance of $_____*

Is To Be Paid In ____ Installments*

Number of installments

Of $____ Per Installment*

Monthly Dues

Which Will Be Billed On The ____ Of Each Month

Numerical Day Of The Month

Starting On ____

MM/DD/YYYY (One Month From Today’s Date)

Last Payment Will Be On ____

MM/DD/YYYY (One Year From Today’s Date)

You Will Make A Total Of ____ Payments*

The First Month You Will Have ____ Training Sessions*

Leaving You ____ Training Sessions On Your Last Month*

Session Expiration Date*

MM/DD/YYYY (2 Weeks After Contract Expiration)

NOTES

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

Total Amount to be paid today:

Credit Card*

Card Details

Cardholder Name