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Bikram Yoga Northville

122 MainCentre Northville, MI 48167

Phone : (248) 924-2002

E-mail : info@bikramyogadetroit.com

AUTO-PAY PLAN ENROLLMENT FORM START STRETCHING YOUR BODY, MIND AND DOLLAR

$ 99 Auto Pay -- one month unlimited yoga $ 89.50 Family Auto Pay -- one month unlimited yoga / person (fees drafted from one account)$ 79 Youth/Senior Auto Pay -- one month unlimited with valid ID (22 or under) or senior(60+)

You get:• Unlimited Yoga Classes at Bikram Yoga Northville • Membership discount of 10% off yoga gear, private lessons, massage and workshops! • Get special offers when renewing your autopay contract.

HOW DO I SIGN UP?

Complete the enrollment form, attach a voided check and drop the information at the front desk.

WE MUST HAVE A VOIDED CHECK and a SIGNED Enrollment Form to start your new unlimited membership.

Upon receipt of the enrollment form and voided check your membership will start and $99 and will be debited

from your account within 2 days.

Monthly payments will continue either the 15th or 30th of each month and will renew monthly until you cancel.

BIKRAM YOGA NORTHVILLE 122 MAINCENTRE NORTHVILLE, MI 48167 (248) 924-2002

Bikram Yoga Northville auto-pay plan enrollment form Authorization agreement for pre-authorized monthly payments

Credit card payments (there is an additional $10 service fee)

NAME__________________________________________________________________________________________ d.o.b.____/____/_____

ADDRESS _____________________________________________________CITY __________________________ZIP____________________

EMAIL_______________________________________________________________________Phone_________________________________

CONTRACT AGREEMENTUntil further notice, I hereby authorize Curnett Enterprises, INC to process a monthly debit entry to my bank account in the amount of $99.00 per month, for a minimum of 6 months, for unlimited yoga.

I understand that this agreement requires a minimum 6 month commitment. After the initial 6 month commitment I may terminate this contract by written notification to Curnett Enterprises, INC 15 days or more before my next billing cycle. If notice is given less than 15 days before the next billing cycle the cancellation will not take place until the following month. All class packages are non-refundable, non-transferable, and non-extendable. Cancellations must be given in writing If cancellation occurs before the initial 6 month commitment expire there is a $150 cancellation fee.Any transaction returned for non-payment will be assessed a $15 returned item fee.

Client name______________________________________________Credit card number_________________________________________

Billing Zip Code _________________ Cv code __________________Expiration date ____/_____/________/ Rate_____________________

“Nothing can steal happiness, peace away from you: if anyone does make you angry, you are the loser; if someone can allow you to lose peace, you are the loser“ Bikram Choudhury

Name______________________________________________________DATE __/___/_______/ SIGNATURE ___________________________

Please debit my ( ) Checking Account (ATTACH VOIDED CHECK) ( ) Savings Account (FILL IN BELOW)

Bank Routing#______________________________ Account #___________________________________________ Rate________________

Name____________________________________________________DATE __/___/_______/ SIGNATURE ___________________________

Make payments for $109 per month.

auto pay