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Payment and
Membership Agreement

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants with respect to any aspect of credit transaction on the basis of race, color, religion, national origin, sex or marital status, or age (provided the applicant has the capactiy to contract). The agency that administers with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington D.C. 20580.

If you do not want to fill this out electronically, then click and print the link below.
Click here to print this form You can print the form, sign it, and drop it off at Extreme Fitness.

BUYER INFORMATION

Last Name:	First Name:	Birthdate:
Home Phone:	E-mail:
Mailing Address:	Today's Date:

Employer:

Position:

How Long:

Work Phone:

I ELECT TO PAY MY MONTHLY DUES VIA:

WAIVER AND RELEASE OF LIABILITY

Extreme Fitness urges you and all members to obtain a physical examination form a doctor before using any exercise equipment or participating in any exercise class. All exercises, including the use of weights and use of any and all machinery, equipment, and apparatus designed for exercise shall be at the member’s sole risk. Members understand that the agreement to use, or selection of equipment programs, methods and types of equipment shall be member’s entire responsibility, and Extreme Fitness shall not be liable to member for any claims, demands, injuries, damages, or actions arising due to injury to member’s person or property arising out of or in connection with the use by members of the services, facilities, and premises of Extreme Fitness. Member hereby holds Extreme Fitness, its officers, owners, agents, and employees harmless from all claims which may be brought against them by member or on member’s behalf for any such injuries of claims.

Signed by: (enter first and last name) Date:
Click the submit button to indicate your acceptance of these terms and conditions.

I elect to pay my monthly installment payments be Electronic Funds Transfer (EFT). Initial:

I, , authorize my bank to make my payment by the method indicated below to Extreme Fitness for my Membership Dues.

If Paying By Checking:

Account Number:		Routing Number:
Bank Name:		Bank Phone:

If Paying By Credit Card: You will fill out the information on the next screen - DO NOT FORGET THIS STEP!!

Signed by: (enter first and last name) Date:
Click the submit button to indicate your acceptance of these terms and conditions.

If you do not want to fill this out electronically, then click and print the link below.
Click here to print this form You can print the form, sign it, and drop it off at Extreme Fitness.