EFT Authorization Form

By signing this form, I ____________________________________ understand that I have willfully submitted

my credit/debit card ending in ______ information to authorize YOURBUSINESS for the purpose of automatic
billing. For ___________
Rates
# of Sessions Cost Per Session Total
5
10
15
20
30
40

I understand that I am signing up with YOURBUSINESS to purchase ______ sessions at the cost of
_________per session for a total of _____________. Sessions must be used by _______________

Your Training Schedule

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Session Start/End (Please Initial)______

Part of my responsibility as your trainer is helping you develop discipline. Our time starts at our training time and
ends in ______minutes. If you aren’t ready to train at your appointed time you are wasting your own session.

Session Cancellation Policy(Please Initial)______

If you for whatever reason are unable to make your session please give 24 hours notice of your cancellation to
avoid losing that session. “Rescheduling” within 24 hours of your session is cancelling.

Loss Of Desired Time Slot(Please Initial)______

Please understand that I get paid to train and cancelled sessions are an opportunity lost to train someone else. If
you have to cancel more than ____ sessions, I may not be able to guarantee your day/time moving forward.

Program Cancellation Policy(Please Initial)______

To cancel with YOURBUSINESS. you can go to YOURWEBSITE and fill out the cancelation confirmation form
or email you at YOUREMAIL. I also understand that the YOURBUSINESS can terminate my membership and
refund my account a prorated amount based on the number of sessions used for actions detrimental to the integrity
of the YOURBUSINESS.

Finally I understand that this is a digital signature and will receive a copy of these terms via email within 48 hours
of signing. If, after reviewing I find the terms unfair or different from what was explained to me I will have an
additional 48 hours to have another form signed with appropriate terms or decide not to continue with your
services.

Customer Signature & Date Employee Signature & Date