Forms AUTO PAY Consent Form "*" indicates required fields 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Signature*GymStars, LLC 210 Weiss Ave. St. Louis, MO 63125 GymStars-stl.com (314) 845-6600NameThis field is for validation purposes and should be left unchanged.
