Studio Vitality Terms and Conditions for Autopay Contracts
<AGREEMENTDATE> Between: <CLIENTNAME> and Studio Vitality, LLC for LIMITLESS VITALITY or TOTAL VITALITY.
Contract Start Date: <CONTRACTSTARTDATE>
Contract End Date: <CONTRACTENDDATE>
Contract Duration and Automatic Renewal: Contract is in force for <NUMBEROFPAYMENTS> months from the Contract Start Date, with automatic renewal for subsequent months, unless cancelled by either <CLIENTNAME> or Studio Vitality, LLC with notification of 30 days in advance of the next billing date.
Agreement to Pay Recurring Fees: <CLIENTNAME> agrees to pay Studio Vitality, LLC monthly recurring fees as follows:
<AUTOPAYITEM> for <AUTOPAYAMOUNT> via Client authorized automatic credit card or checking account ACH charges. Alternatively, Client may prepay six or twelve months in advance via any credit card, ACH, bank check or wire transfer. Payment in monthly increments by any means other than Client's credit card or ACH is not permitted.
Please read and sign below.
(a) I agree to purchase the <AUTOPAYITEM> for <AUTOPAYAMOUNT>, as an automatic charge to my credit card, or automatic debit to my checking account each month for a contract period of <NUMBEROFPAYMENTS> months.
(b) I hereby certify that I am the holder of the credit card, or an authorized signer on the bank checking account detailed below.
(c) I understand that I will be notified if my credit card or checking account payment fails to authorize for any reason, and that a $10 late fee will apply if I do not provide a valid credit card or checking account ACH information within 10 calendar days of the original rejection date.
(d) I understand that my service will be deactivated if my account becomes more than 30 calendar days late.
Signature: _______________________________________Date: ____________
Printed Name: ____________________________________
FOR CHECKING ACCOUNT AUTO-DEBIT (ACH)
BANK NAME: _____________________________________________________
NAME ON ACCOUNT: _____________________________________________
AUTHORIZED SIGNER NAME: _______________________________________
SIGNATURE OF ABOVE: ___________________________________________
RTN NUMBER: ___________________________________________________
ACCOUNT NUMBER: ______________________________________________
Freeze your autopay
To freeze your autopay, a completed request must be submitted in writing at least 30 days in advance of your next billing date in order for your request to be effective from the following month. Billing date is based on your activation date listed below.
Students enrolled in the monthly auto renew program may elect to freeze their autopay charges once per year according to the policy below:
You can freeze your autopay schedule once per year at any time for a fee of $15 per month. The freeze is activated at the start of the next billing cycle and can be requested in monthly increments for up to 6 months.
To request the freeze, complete a freeze request form at the front desk and submit it via fax or in person to the front desk.
Following the end of your requested freeze period, your monthly auto-renew will automatically be reactivated. Your autopay schedule may be canceled at any time.
A completed autopay cancellation form must be received at least 30 days in advance of your billing cycle (example: if you are scheduled to be charged February 14th and you want to cancel for the month of February, you must submit a cancellation form to Studio Vitality, LLC by January 14th.)