Club # 3916 Member # ________________________
St. Louis Workout, Inc.
MEMBERSHIP AGREEMENT
Retail Installment Contract
245 Union Blvd.
St. Louis, MO 63108
(314) 367-2233
Original Member’s (Buyer’s) Name:_______________________________________________________________ Birth Date: __________/__________/__________ Age: __________ Sex: M F
Social Security #:_______________________________________________________
Family Members on Account: _______________________________________________________________ Birth Date: __________/__________/__________ Age: __________ Sex: M F
_______________________________________________________________ Birth Date: __________/__________/__________ Age: __________ Sex: M F
_______________________________________________________________ Birth Date: __________/__________/__________ Age: __________ Sex: M F
Address:____________________________________________________________________________ City:_________________________________________ State:____________ Zip:_______________
Phone: [H] (_________)_________________________________ [W] (_________)_________________________________ Email:________________________________________________________
Contract begins _______/_______/_______ and expires _______/_______/_______
1 Year Membership Price $_______________ Down Payment: $____________
2 Year Membership Price $_______________ Unpaid Balance $____________
3 Year Membership Price $_______________ Sales Tax at ________________%
Pay As You Go Membership Price $_______________
AUTOMATIC RENEWAL PROGRAM:
Subject to the terms and conditions hereof, the membership will automatically renew for the rate indicated below. Subsequent monthly dues after the applicable term may be cancelled upon a 60 days prior written notice in accordance to paragraph 7 hereof. It is also understood that the club has the option to increase monthly renewal dues without notice during any renewal period not to exceed $________ per month.
TOTAL AMOUNT: $_____________ PER MONTH FOR
FUTURE AUTOMATIC RENEWAL.
Renewal Date:_________/_________/_________
Member’s Initials: _______________
1st Payment Schedule: DUES
Number of Payments Monthly Payment Amount First Due Date
2nd Payment Schedule:
Number of Payments Monthly Payment Amount First Due Date
PLEASE ATTACH A VOID OR BLANK CHECK
REQUEST FOR PREAUTHORIZED PAYMENT
I/We hereby request the privilege of paying to ABC Financial Services, Inc (“The Company”), Sherwood, AR 72124, and further authorize the Company to draw items (checks, electronic fund transfers, charge card) for the purpose of paying said payments, including any late fees or service fees, on the account of
REQUIRED FOR ALL
EFT AND CREDIT CARD
DRAFT ACCOUNTS
(Name as shown on account)
c American Express Acct. # ___________________________________________________________ Exp. Date ________/________/________
c MasterCard Acct. # ________________________________________________________________ Exp. Date ________/________/________
c Visa Acct. # _______________________________________________________________________ Exp. Date ________/________/________
c Discover Acct. # ___________________________________________________________________ Exp. Date ________/________/________
c Diners Club Acct. # _________________________________________________________________ Exp. Date ________/________/________
c Checking Acct. c Savings Acct._____________________________________________________________________________________________________
______________________________________________
______________________________________________
(15 digits)
(16 digits)
(13 or 16 digits)
(16 digits)
(14 digits)
ROUTING NUMBER (9 Digits)
ACCOUNT NUMBER
BANK NAME
Subject to the following conditions:
(1) The items shall be drawn on or about the date or dates of the Payment Schedule. The transactions on your bank statement will constitute receipts for payment on your account.
(2) If the regular payments set forth on the Payment Schedule should vary in amount, you are entitled to notice at least 10 days before each payment of when it will be made and how much it will be. However, by executing this preauthorization, you choose to instead get this notice only when the payment would differ by more than $50.00 from the most recent payment.
(3) By executing this agreement, you acknowledge your awareness that certain disclosures required by the Electronic Funds Transfer Act and its regulations are available for your review at the Company’s website: www.abcfinancial.com under terms and conditions.
(4) The privilege of making payments under this arrangement may be revoked by the Company if any item is not paid upon presentation.
(5) If this preauthorization payment arrangement is revoked for any reason, this does not release you from your obligation (Payment Schedule).
(6) A service fee will be assessed and drafted for any check, draft, credit card, or order returned for insufficient funds or any other reason. A late fee will be assessed and drafted should any monthly payment become past due.
(7) This preauthorization payment arrangement shall apply to the following Applicant(s):
Date ____________________ Customer Signature _____________________________________________________________________________________________
(Signature required only if name on account is different than member)
MEMBERSHIP TERMS: In consideration of membership to St. Louis Workout, Inc. I have selected an annual dues membership plan for __________ year(s), my initial membership term, and agree to either pay the membership in full for the time period selected on the day of enrollment, or pay it monthly. If paid monthly, I understand I am enrolling for ___________ month commitment period and my monthly membership payments must be satisfied through monthly deduction from my MC/Visa credit card or bank checking account. I further understand after my initial membership term, my membership is automatically renewable each month after the initial term at the renewal dues rate described above, and that all renewal monthly dues must be satisfied per automatic debit from my MC/Visa credit card or bank checking account. I understand that my annual dues membership may only be cancelled in accordance with paragraphs 7 through 10 hereof. Subsequent monthly dues after the applicable membership term may be cancelled upon 60 days prior written notice in accordance with paragraph 7 hereof. FAILURE TO USE THE CLUB FACILITIES DOES NOT RELIEVE MEMBER’S OBLIGATION UNDER THIS AGREEMENT.
BUYER’S RIGHT TO CANCEL: If you wish to cancel this Agreement, you may cancel by delivering written notice personally or by certified mail, return receipt requested. The notice must state that you do not wish to be bound by this Agreement and must be delivered or mailed before midnight of the third (3rd) business day after you sign this Agreement and must be accompanied by the original documents delivered to you by us at the time this Agreement was signed. A business day is any day except a Sunday or a legal holiday. You may retain a copy of the original documents delivered to you by us at the time this Agreement was signed. This notice must be delivered personally or by certified mail, return receipt requested to St. Louis Workout, Inc. 626 Crestwood Plaza, St. Louis, MO 63126. We will refund to you all monies paid under this Agreement within thirty days of receipt of such notice. If you purchase a plan at a facility which has not yet opened for busienss at the time this Agreement is signed, or if you do not execute this Agreement at an existing facility, you have seven (7) calendar days in which to cancel this Agreement and receive a full refund of all monies paid. Your rights to cancel described herein are in addition to any other Contract rights or remedies provided by the law.
NOTICE TO THE BUYER: (1) DO NOT SIGN THIS CONTRACT BEFORE YOU READ IT OR IF IT CONTAINS ANY BLANK SPACES. (2) YOU ARE ENTITLED TO AN EXACT COPY OF THE CONTRACT YOU SIGN. (3) UNDER THE LAW YOU HAVE THE RIGHT TO PAY OFF IN ADVANCE THE FULL AMOUNT DUE AND UNDER CERTAIN CIRCUMSTANCES TO OBTAIN A PARTIAL REFUND OF THE TIME CHARGE (FINANCE CHARGE).
WAIVER AND RELEASE: THIS CONTRACT CONTAINS A WAIVER AND RELEASE TO WHICH YOU WILL BE BOUND. BY SIGNING BELOW, YOU ACKNOWLEDGE RECEIPT OF A FULLY COMPLETED COPY OF THIS CONTRACT EXECUTED BY BOTH YOU AND US AND OF A COPY OF THE RULES AND REGULATIONS.
Dated this ___________ day of ____________________________________, 20___________.
_______________________________________________________________ _______________________________________________________________
Original Member (Buyer’s) Signature St. Louis Workout, Inc Representative Signature
1. ADDITIONAL NOTICES TO MEMBER: This contract contains a waiver of liability, release, and express assumption of risk to which you will be bound. You acknowledge that you have carefully read this WAIVER AND RELEASE and understand that it is a release of liability, express assumption of risk and indemnity agreement. By executing this agreement, you are giving up your right to bring legal action or assert a claim against St. Louis Workout, Inc. for its negligence or for any defective product on its premises. You have read and voluntarily signed the waiver and release and further agree that no oral representations or inducement apart from the foregoing written agreement have been made.
2. DEFAULT AND LATE PAYMENTS: Should you default on any payment obligation as called for in this agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. A default occurs when any payment due under this agreement is more than ten days late. Should any monthly payment become more than ten days past due, you will be charged a late fee. An additional service fee will be assessed for any check, draft, credit card, or order returned for insufficient funds or any other reason. If the Member is paying monthly dues by electronic funds transfer (EFT), the club’s billing company, ABC Financial Services, Inc., reserves the right to draft via EFT all amounts owed by the member including any and all late fees and service fees. Subject to appropriate State and Federal Law. Member also understands and agrees that he or she will be responsible for the greater of the remaining term of the membership or six months of membership fees for Pay As You Go memberships, after the initial payment delinquency and/or default occurs, provided that the Member does not follow the cancellation procedures set forth in this Agreement. This is in addition to any other fees Member may be responsible for as stated in this paragraph or any other provision in this Agreement.
3. MEMBERSHIP RULES AND REGULATIONS: By signing this agreement, I agree to adhere and follow all of the rules and regulations now in force or in the future adopted by St. Louis Workout, Inc. and our affiliates, related entities, employees, agents, representatives, successors, and assigns (hereafter “CLUB”), including, but not limited to, rules and regulations with regard to hours of operations, use of equipment and facilities, personal hygiene, and attire. St. Louis Workout, Inc. reserves the exclusive right to revoke or suspend your membership, without refund, if you or your guest violate any of the rules and regulations for reasons of nuisance, disturbance of other members and/or guests, moral turpitude or fraud, or if we determine your actions may endanger yourself or other members, guests, or staff. It is prohibited for any member or guest to conduct, purchase, or subscribe to any commercial business or activity or solicit any business competitive with that of the CLUB, including personal training, class instruction, nutritional supplemental/services, while on premises, without the prior consent of St. Louis Workout, Inc. Members and their guests agree to check-in at the front desk for each visit to the club and understand their membership must be current and valid to access our facilities, and member will not allow any other individual to use their membership and will not disclose their confidential membership identification number to anyone else. All members must be at least 12 years of age to access full membership privileges. St. Louis Workout, Inc. is not responsible for lost, stolen, or damaged articles. The Buyer acknowledges and agrees that St. Louis Workout, Inc., its officers, agents, and employees will not be liable for either loss of, damage to or stolen Member’s property or Member’s personal possessions within or outside the CLUB’s premises, including the parking and surrounding building facilities. Hours and days of operation shall be posted on premises, and shall be subject to reasonable change at the sole discretion of the CLUB. Kid’s Klub, Specialty Classes, Personal Training, and all other ancillary services that St. Louis Workout, Inc. offers are only available to club members at the club posted rate. Kid’s Klub babysitting services are only available to members for a maximum of 2 hours per day, and only while member is on club premises. St. Louis Workout, Inc. reserves the right to increase a member’s dues after their initial term of membership a maximum of 10% on an annual basis. Members may bring guests, who must pay guest fees for services. Guests of members must also authorize a waiver/release and must be under full supervision by St. Louis Workout, Inc. Staff during their visit. Members may bring as many individual guests as they would like for any one visit, provided the same particular guest does not come into the CLUB as a guest more than 1 time per month and more than 3 times per year. A bonus may be granted to the Buyer, either in the form of an extended term of usage, a cash discount or gift, based solely on the Buyer’s representation that this agreement is being entered into on Buyer’s first visit to any St. Louis Workout, Inc. facility. Should such representation prove incorrect, Buyer and/or Member shall lose benefit of such bonus. St. Louis Workout, Inc. reserves the right to add, change, alter, amend or cease any service or amenity at any time at Company’s sole discretion and any such change or modification performed by St. Louis Workout, Inc. to any such services will in no way cause a breach by the Company to the terms of this Contract.
4. ASSUMPTION OF RISK: You agree that if you engage in any physical exercise or activity or use any CLUB facility on the premises, you do so at your own risk and assume the risk of any and all injury and/or damage while engaging in any physical exercise or activity or use of any CLUB facility or equipment on the premises, including injuries or damages arising out of the negligence of CLUB, whether active or passive, or any of its affiliates, employees, agents, representatives, successors, and assigns. Your assumption of risk includes, without limitation, your use of any exercise equipment (mechanical or otherwise), the locker room, sidewalk, parking lot, stairs, pool, whirlpool, sauna, steam room, lobby area, or any equipment in the CLUB facility. You agree to assume all risk in your participation in any activity, class program, instruction, or CLUB sponsored event, including but not limited to weight lifting, walking, jogging, running, aerobic activities, basketball, volleyball, and racquetball. You agree that you are voluntarily participating in the aforementioned activities and using the CLUB facilities and premises and assume all risk of injury, illness, damage, or loss to you or your property that might result.
5. RELEASE: You agree on behalf of yourself (and all your personal representatives, heirs, executors, administrators, agents, and assigns) to release and discharge CLUB from any and all claims or causes of action (known or unknown) arising out of the negligence of CLUB, whether active or passive. This waiver and release of liability includes, without limitation, injuries which may occur as a result of (a) your use of any exercise equipment or facilities which may malfunction or break, (b) CLUB’s improper maintenance of any exercise equipment, premises or facilities, (c) CLUB’s negligent instruction or supervision, including personal training, and (d) you slipping and falling while on the facility or any portion of the premises for any reason, including CLUB’s negligent inspection or maintenance of its facility.
6. INDEMNIFICATION: By execution of this agreement, you agree to indemnify and hold harmless CLUB from any loss, liability, damage, or cost CLUB may incur due to your presence at the CLUB facility. You expressly agree that the foregoing release, waiver, assumption of risk and indemnity agreement is intended to be as broad and inclusive as permitted by the law in the State of Missouri and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. You acknowledge that the CLUB is designed to and does offer a service to its members encompassing the entire fitness spectrum. The CLUB is not in the business of selling weight lifting equipment, exercise equipment, or other such products to the public, and the use of such items is incidental to the service provided by the CLUB. You acknowledge and agree that the CLUB does not place such items into the stream of commerce.
7. BUYER’S RIGHT TO CANCEL: If you wish to cancel a membership as provided in paragraphs 7 through 10 below, you should notify us in writing and provide the requested information by certified mail, return receipt requested, or personal delivery to St. Louis Workout, Inc. 626 Crestwood Plaza, St. Louis, MO 63126. Cancellation of Pay As You Go Memberships or Annual Memberships which have been automatically renewed on a monthly basis after the expiration of the initial annual term, require a 60-day advance written notice, at the address indicated in this paragraph, and the payment of any past due amounts owed the CLUB. All monies to be refunded upon cancellation shall be paid within thirty days of receipt of the notice of cancellation. If you lose your copy of this Agreement, CLUB may charge you a fee of $10.00 for a replacement copy.
8. CANCELLATION UPON DEATH OR DISABILITY: You or your estate have the right to cancel Member’s membership if Member dies or becomes permanently disabled and unable to use a substantial portion of the services for sixty or more consecutive days. To cancel under this paragraph, send to our office at 626 Crestwood Plaza, St. Louis, MO 63126, written notice and proof of death or a written certification of such disability by a doctor licensed under this state which includes the following information: diagnosis, extent of disability, date of onset, and estimated duration of disability. Please return any documents received at or after this Agreement was signed evidencing Member’s membership in the health club. Your cancellation will be effective when our firm receives all correct and required information. You agree that we may verify Member’s disability directly with Member’s doctor or by having Member submit to a physical examination by a doctor agreeable to Member and us. In the event of a temporary disability which continues for a period less than sixty days, we will extend the membership term for time lost due to the temporary disability upon receipt of written certification of such temporary disability by a doctor licensed under this state. You must continue to make all scheduled payments due under this Agreement. We may verify such temporary disability in the same manner set out above. Upon our receipt of written notice and other required information, you will receive a prorata refund of the amounts paid or accepted in payment of the membership which are allocable after the date of cancellation. Refunds of the membership fee are prorated over the term of the plan. Monthly dues allocable to periods after cancellation will be refunded. Buyer remains obligated for payments for other Members not entitled to cancel under this paragraph.
9. CANCELLATION UPON RELOCATION: You may cancel the membership of Member if Member permanently moves Member’s residence more than 25 driving miles from either the club of enrollment or any other club which Member is entitled to use under the membership plan chosen, or any substantially similar facility which will honor Member’s membership at no additional charge. If any of these clubs are within 25 driving miles of the new residence, you will not be permitted to cancel Member’s membership. Member will be required to adhere to the rules of any club to which Member transfers Member’s membership. To cancel under this paragraph, send to our office any two of the following items as proof of your new permanent residence: a current and valid lease, a utility bill, a bank statement or credit card bill, a yellow change of address label indicating mail was forwarded to your new address, or your new driver’s license with issue date. You must also send a $50 cancellation fee and return any documents received at or after this Contract was signed evidencing Member’s membership in health club. Your cancellation will be effective only when we receive all these items. Following cancellation, you will receive a prorata refund of the membership fee paid, which is allocable after the date of cancellation fee. Monthly dues allocable to periods after cancellation will be refunded.
10. OTHER CANCELLATION RIGHTS: You may cancel the membership of Member if the club of enrollment permanently relocates 10 or more miles from the location specified in this Agreement or goes out of business and we fail to provide an alternative club within ten miles of the location specified in this Agreement which member is entitled to use under the membership plan chosen and which will honor the membership at no additional charge. If any of these clubs are within ten miles of the location specified in this Agreement, you will not be permitted to cancel Member’s membership. Member will be required to adhere to the rules of any club to which member transfers the membership. To cancel under this paragraph send written notice to our office. Please return Member’s membership card and any other documents received at or after this Agreement was signed, evidencing membership in the health club. Upon our receipt of written notice and other required information, you will receive a prorata refund of the amounts paid or accepted in payment of the membership which are allocable after the date of the club closing. Refunds of the membership fee are prorated over 36 months from the Agreement date, except that refunds of the membership fee for nonrenewable membership plans are prorated over the term of the plan. Monthly dues allocable to periods after cancellation will be refunded. Buyer remains obligated for payments for other Members not entitled to cancel under this paragraph.
11. St. Louis Workout reserves the right to assign this contract to a third party agency for the capturing of membership dues payments at the sole discretion of the CLUB.