Membership #
75 US Rt 1 Bypass
Kittery, ME 03904
Tel. 207-438-0888
200 Larrabee Road
Westbrook, ME 04092
207.856.5666
www.CoastalFitnessOnline.com
First Name
Last
Middle Initial
Mailing Address
(
Birth date
City
)
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Primary Phone Number
State
Zip
MALE
 FEMALE
)
Work Phone
E-mail Address
Membership Privileges, Notices, Disclosures & Agreements
PAYMENT AUTHORIZATION
MEMBERSHIP TYPE:
Billing for Monthly Dues. This agreement authorizes Coastal Fitness to
bill your bank account or credit card for your monthly dues and your
yearly fee (CC EFT, preauthorized check or credit card charge) Your
account will be billed monthly on or shortly following the date of your
payment schedule.
If a check, draft, or order of payment of money on any bank or any
depository submitted by you to Seller as payment is not honored by the
bank, then Seller may add a fee of ($20.00) Twenty dollars or 5% of the
face amount of the check, draft, or order, whichever is greater, to the
unpaid balance under the contract unless the check, draft, or order is
made good within (10) ten days after Seller gives you written notice of
the bank’s dishonor.
* We are not responsible for notifying you of late payments, or any
default proceedings.
* We will apply all payments received to pay the installments
(including late charges, if any) in the order in which they are
scheduled to be paid.
NOTICE TO BUYER: DO NOT SIGN THIS CONTRACT UNLESS YOU
HAVE READ IT ALL. ALSO, DO NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES. YOU MAY CANCEL THIS
TRANSACTION IN WRITING ANY TIME PRIOR TO MIDNIGHT OF THE
THIRD BUSINESS DAY AFTER THIS TRANSACTION.
ANY PAID IN FULL MEMBERSHIPS ARE NONTRANSFERABLE,
NONASSIGNABLE, NONREFUNDABLE.
MEMBER’S INITIALS ______________
 PIF
 Monthly
 Class
 Floor
1.
Your Membership begins :
______/_____/ ____
2.
Your PIF Membership expires:
______/_____/ ____
3.
Enrollment Fee:
$ _______________
4.
Prorated Dues:
$ _______________
5.
Prepay:
$ _______________
6.
Total Sale Price:
$ _______________
Payment Schedule: DUES
Monthly Payment Amount
1st Payment Due Date
ANNUAL MEMBERSHIP FEE: A fee of $19.99 will be billed
annually with my billing for ______________________ and
taken out of my account. I have read and fully understand the
cancellation policy and billing procedure.
Member’s Initials _________
REQUIRED FOR ALL EFT AND CREDIT CARD DRAFT ACCOUNTS
PLEASE ATTACH A VOID OR BLANK CHECK REQUEST FOR PREAUTHORIZED PAYMENT
PRINT NAME AS IT APPEARS ON THE ACCOUNT ________________________________________________________________________________________________
 VISA
 MASTERCARD
 AMERICAN EXPRESS
 DISCOVER
CREDIT/DEBIT CARD NUMBER _______________________________________________________________________ EXP. DATE __________
 CHECKING
 SAVINGS
/
BANK NAME ________________________________________________________________________________________________
ROUTING NUMBER (9 DIGITS) _______________________________________ ACCOUNT NUMBER ________________________________________________________
DATE
ACCOUNT HOLDER SIGNATURE (REQUIRED ONLY IF DIFFERENT FROM MEMBER)
ADDITIONAL TERMS AND CONDITIONS
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Coastal Fitness will refund you the pro-rated cost of any unused services and cancel this contract, within 15 days after receipt, if: you are
unable to receive benefits from our services by reason of death or disability.
Coastal Fitness will refund to you the pro-rated cost of any unused services within 15 days after the club ceases operation.
Monthly memberships may be frozen for a fee of ten dollars ($5.00) per month.
Membership and annual membership fee is absolutely nontransferable, nonassignable, nonrefundable.
Coastal Fitness reserves the right to discontinue any program at any time.
If rates will be increased due to club population or usage it will occur in the month of January.
Cancellation of monthly membership is to be made in person or by certified mail to Coastal Fitness at the address above and
must be made by the 20th of the month. Cancellations by phone or fax will not be accepted.
Member’s Initials
I realize and understand my rights of not signing if there are any unfilled blanks, my rights of cancellation and refund policies as listed in
the contract. I further realize that I must obey the rules of Coastal Fitness and that Coastal Fitness has reserved the right to refund the prorated cost of any unused services and remove me from Coastal Fitness at any time that my actions violate the rules of Coastal Fitness.
Children under the age of 13 are not allowed in the equipment, stretching or cardio areas, or any other Fitness Center Area.
You agree to pay an extra charge for damage arising from any careless use of equipment or dropping of weights, etc... caused by you.
The club, the corporation owning the club, and the agents and employees of both shall not be responsible for damaged, lost or stolen
articles of clothing or any other personal property of any member.
Invalid Provision: If any part of this contract is found to be invalid or unenforceable, the remainder of the contract will be valid and
enforceable.
Attorney Fees, Collection Fees and Court Costs: if your failure to pay any one or more of the installments due under the contract terms
results in Sellers’s retaining an attorney or Collection Agency for collection proceedings, you shall pay any attorney fees, court costs and / or collection
agency fees allowed by law.
RELEASE AGREEMENT
It is expressly agreed that all exercise shall be undertaken by me at my sole personal risk and that Coastal Fitness , its owners,
employees, and agents shall not be liable to me for any claims, demands, actions or causes of action whatsoever, to my person or property
arising out of or connected with the use by me of the service and facilities of Coastal Fitness.
I do hereby expressly forever release and discharge Coastal Fitness from all such claims, demands, injuries, damages, actions or causes
of action and will indemnify Coastal Fitness, its agents or employees against any damages and costs including legal fees from any such
claims.
I have read and understand and voluntarily sign the foregoing Release and Indemnity Agreement, and I have received a copy of this
CONTRACT and release agreement. This constitutes the entire agreement between Coastal Fitness and the member.
Membership Signature
Date
Coastal Fitness Authorized Signature
Legal Guardian Signature if under 18 years of age
Date
Annual membership fee will be billed on May 1st for members joining November 1st thru February 28th, September 1st for members joining
March1st thru June 30th, and January 1st for members joining July 1st thru October 31st.
Date