AUTO PAY Form

Sign Our Auto Pay Form for Hassle-Free Billing at GymStars

Student Name:*
First Last
Parents Name:*
Phone:*
I hereby authorize GymStars, LLC to charge the following credit card amounts that I may incur for tuition, registration and pro shop items. I understand that GymStars, LLC will keep this information private and confidential. This agreement is valid until cancelled by me, the card owner. AUTO PAY needs to be cancelled in writing 2 weeks prior to the next billing cycle.

PAYMENTS WILL BE DRAWN ONE WEEK BEFORE THE 1st DAY OF SESSION
All fields are required!
Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Signature*
Date*
Date Format: MM slash DD slash YYYY
GymStars, LLC 210 Weiss Ave. St. Louis, MO 63125 GymStars-stl.com (314) 845-6600