Big Fitness FlexPay Application Form

Company Name


Full Name
Address


City, State
Zip
Daytime Phone
Email
Evening Phone


Social Security #


Drivers License #
Drivers License State




Bank Name


Bank Address


Bank City, State Bank Zip
Name on Bank Account

Routing Number
 Account Number
Account Type





Item


Amount
 One payment of $0.00
Two payments of $0.00
TOTAL: $0.00



FLEXPAY TERMS AND CONDITIONS

Your bank account will be deducted via ACH in the amounts described above.

  • The first payment -- 50% of the purcase price -- will be charged within one business day.
  • The second payment -- 25% of the purchase price -- will be charged 30 days from the date of the first charge and
  • The third and final payment -- 25% of the purchase price -- will be charged 60 days from the date of the first charge.

Purchases in the amount of $500 or more will require a copy of a voided check to be faxed to us at 401-725-6264.


I agree to the Big Fitness FlexPay Terms and Conditions.