Credit card authorization form - MN Personal Training 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Fitness Center Name, which is Total Wellness Coaching LLC, and your Member ID # if applicable.
3. Fill in your Member Name and the dates for the first and last payments. Leave the last payment date blank if not applicable.
4. Select your preferred payment date by checking the appropriate box (1st or another date).
5. Indicate the amount of your monthly payment in the designated field.
6. Provide your personal details including Last Name, First Name, Address, City, State, Zip, and Email.
7. Choose whether to debit from a Savings or Checking account. If using a Checking account, attach a voided check.
8. Enter your Routing Number and Account Number as required.
9. Sign and date the authorization section for debit entries.
10. If paying by credit card, fill in the Credit Card Number, select the card type (Visa, MasterCard, Discover), and provide the Expiration Date and Name on Card.
11. Complete any additional billing address information if it differs from above.
12. Sign as it appears on the credit card and date this section as well.

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