Credit Card Authorization Form
In completing this form, you are authorizing UNICUS Fitness to charge your credit card in the amount of $135 for the number of months selected below. Charges will be made on or around the 1st or 15th each month (you choose which date is best for you). A minimum of 3 months on Electronic Funds Transfer (EFT) is required to get the $135/month rate. Accounts that are canceled prior to the 3 months will incur a $150 fee. All payments will be processed on the first of the month.
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indicates required fields
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First Name:
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Last Name:
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Address:
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Email Address:
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Phone Number:
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Credit Card Type:
Visa
Mastercard
Discover
America Express
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Credit Card Number:
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Expiration Date:
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3 Digit Code:
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Which Program Are You Enrolling In?::
Beach Body Emergnecy- The Fitness Lair 6am (W/F only)
Beach Body Emergnecy- The Fitness Lair 5:30pm
Beach Body Emergnecy- The Fitness Lair 7pm
Beach Body Emergnecy- Chatham Center 7pm
Beach Body Emergnecy- Just For Kicks 7:15pm
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Select Your Start Date:
January 11
February 8
March 8
April 5
May 3
June 7
July 5
Aug 2
Aug 30
Sept 27
Oct 25
Nov 29
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Enrollment Length:
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
12 Months
After filling the details click on the SUBMIT button.
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