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2. Primary Member Information
4. Last Name*
5. First Name*
7. Primary Phone Number*
8. Secondary Phone Number
10. Email Address*
12. Address1*
14. City*
15. State*
16. Zip*
18. Primary Name on the Membership Account, if different
20. Address2
24. Bank Draft Policy

    Members may request to update their account on file and/or their scheduled payment date via. The primary member will receive a new Bank Draft Authorization form via DocuSign and will need to provide signature and a Voided check in the member's name. To ensure the change is made before the next draft date, DocuSign must be completed in the timeframe requested by our team. Members may be charged a $25 administration fee for any changes to their bank account or scheduled payment date.

    
    

26. What change are you requesting?*

    1. Change My Checking Account for Billing
    2. Change My Draft Date for Billing
28. When will this change be effective? *
    Please provide month and year. MM/YY For bank draft changes and downgrades, 15-days notice is required. Prorated membership fees apply for upgrades based on effective and draft dates.
30. Do you have any comments or questions?
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field