Billing Change Form
Visa
Mastercard
American Express Discover
Billing Type
Card Number:
Expiration Date:
CVS Code:
Card Holder Name:
Account Type
Checking
Savings
Account Number:
Routing Number:
I authorize VASA Fitness to update my account with the information on this form. I
understand that this will replace any previous credit card or ach information on my
account to collect any further payments.