Spa Lady Health Club

*Effective 10/1/06 the State of NJ will impose a 7% sales tax on all health club memberships.

*For monthly members only:
If you wish to sign up for EFT (electronic funds transfer) or are already an EFT member & wish to change your billing information, please fill out the form below & press submit.
*Remember, we require one full calendar months notice to make changes to billing!

Your Billing Information:
*Full Name:
*Address:
*City/State/Zip:
*Phone # in case we have questions:
*E Mail Address:
*Membership #:
*Specify type of account:	Checking account Credit card Debit Card
*If checking account, please enter name of bank:
*Name on the checking account:
*Routing number:
*Account #:
*If credit card or debit card enter account # here:
*Exp. date:
*Name on the card:
*3 digit # on the back:
*I authorize Spa Lady to make a debit entry to my account without further signature. Type initials:

Please type the text that appears in the picture below: