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Client Information Form
First name
Last name
Email
Phone
Street Address
Street Address Line 2
City
Region/State/Province
Postal / Zip code
Trainer's Name
Trainer's Phone Number
Credit Card Type
Credit Card #
Exact Name on Card
Billing Zip Code
Expiration
Security Code
By submitting this form, I am authorizing that services rendered may be charged to the credit card listed above.Â
Please check this box if you would prefer to recieve a QUICKBOOKS INVOICE sent to your email. Your credit card will be kept on file for outstanding balances past due more than 60 days.
Please enter any comments or questions here associated with your new client account.
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