APPLICANT’S BILLING TERMS AND APPLICATION FORM *

First Name

Last Name

Phone *

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Start Date *

MM

DD

YYYY

MEMBERSHIP DUES: *

All membership dues require automatic recurring payment for an active term + Initiation fee: $65.00 (1 time payment) 30 days cancellation policy applies.

Open Gym Membership: Regular Open Gym Use (No Contract, Month-to-Month only with recurring payment)

Certified Personal Trainer’s

Private Training

Others:

Automatic Recurring Payment Authorization Form *

Schedule your payment to be automatically deducted or charged to your Visa, MasterCard, American Express or Discover Card. Just complete and sign this form to get started! Recurring Payments Will Make Your Life Easier: • It’s convenient. • Your payment is always on time (even if you’re out of town), eliminating late charges. Here’s How Recurring Payments Work: You authorize regularly scheduled charges to your debit account or credit card. You will be charged the amount indicated below each billing period. A receipt for each payment will be emailed to you and the charge will appear on your bank statement as an “FulHaus Club.” You agree that no prior- notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected. Please complete the information below:

I hereby authorize FulHaus Club to charge my credit card or debit card indicated above each billing cycle for payment of my FulHaus Club membership. Such fee shall be charged on the credit card.

Credit/Debit Card *

Visa

MasterCard

Amex

Discover

BILLING / TERMS / AGREEMENT *

I apply for membership in the FulHaus Club. I represent and warrant that I am 18 years of age or older and all facts and information set forth above and/or in the Membership Application dated this date (the Application ) are true, correct and complete. The Application is incorporated by reference and made a part of this Contact.

PAYMENT: I agree and must pay the Total Due Today upon signing this Contract. I also agree If I change financial institutions, I will provide FulHaus Club all information needed for the replacement automatic withdrawal at least ten (10) days before the effective date of the change. I agree and acknowledge that the automatic withdrawals (payments) will continue for that period of subscription I chose above unless I terminate my membership as permitted in this agreement.

TERMS: I agreed and acknowledged by signing this agreement. My memberships may thereafter be renewed at the then current membership rate. By mutual agreement, one type of membership may be converted to another type of membership pursuant to a new contract with FulHaus Club. The terms of this agreement may be extended as follows: a. If FulHaus Club temporarily closes for thirty (30) days or less, the term shall be extended for the number of days equal to the number of days that the facility was closed (excluding holidays and any other days the facility is normally closed), at no additional cost to me. b. I may extend the term of this Contract, at no additional cost to me, for the number of days equal to the days comprising the duration of my disability, if my disability precludes me from using one-third (1/3) or more of the Club’s facilities for a period of less than six (6) months and that disability is verified by a physician. To extend the term pursuant to this Paragraph 4. I must give timely notice to FulHaus Club of my request to so extend.

CANCELLATION: I understand that this authorization will remain in effect until I cancel and provide a written notice, and I agree to notify FulHaus Club of any changes in my account information. I further agree to provide advance notice at least 30 days prior to cancellation of this agreement to proceed with termination of membership otherwise Fulhaus is authorize for another billing cycle to cover the next 30-days. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. Failure to provide advance notice and If billing cycle falls short 30 days within timely billing cycle, membership due will be automatically bill for the next billing cycle and cancellation will apply thereafter. For debits to my checking/ savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an transaction being rejected for Non Sufficient Funds (NSF) or Change of Billing Information(CBI); I understand that FulHaus Club may at its discretion attempt to process the charge again within 90 days. I acknowledge that the origination of transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/debit card and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form.

FEE GUARANTEE: Membership fees may be modified from time-to-time by FulHaus Club. However, no membership fee change will be applicable to me during the initial term of this Contract (but will be effective for any renewal periods).

MEMBERSHIP PRIVILEGES: I will have access to all designated fitness training rooms, outdoor area, member activities and events and promotional fitness activities such as open lounge at no additional charge.

MEMBERS RESPONSIBILITY: All use of the facility shall be undertaken at my sole risk, and FulHaus Club and/or its Owner and Manager shall not be liable for any harm, injuries or damage to me or my property, or be subject to any claim, demand, liability or damages whatsoever, including, without limitation, those resulting from acts of active or passive negligence on the part of FulHaus Club and/or its Owner and Manager, its successors or assigns, as well as its officers and agents, for all such claims, demands, liabilities, damages, actions or causes of actions. It is specifically agreed that FulHaus Club and all the staffs employed shall not be responsible or liable for articles lost, damaged or stolen in, about or in connection with the facility nor for loss or damage to any other of my property, including automobiles and contents. It is also agreed that any damages to FulHaus Club and/or its Owner and all other staff employed, or the facility or its contents, or property or the property of any member by another member is the sole responsibility of the offending member. The foregoing notwithstanding, neither FulHaus Club nor its Owner and Manager shall be relieved by this Paragraph from liability for its own gross negligence and/or willful misconduct.

I signee have verified and agreed to FulHaus Club's Terms

Emergency Contact Person *

First Name

Last Name

I, the undersigned *

being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in a physical activity. Having such knowledge, I hereby acknowledge this release, any representatives, agents, and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program.

I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in said fitness program.

Current Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country