Health Club Direct Debit Suspension Application Request Form

Direct Debit Suspension Application Request Form
Select your centre*
Select Membership Type *
Name*

First NameLast Name
Additional Members
Email*
example@example.com
Debit Success Reference Number
Please note - your reference number can be found in your initial welcome email
Mobile*
0400 000 000
Membership Payment Method*

Direct Debit
Suspend Membership from*

DayMonthYear
Select Start Date (Please pick a future date)
Suspend Membership to*

DayMonthYear
Select End Date (Please pick a future date)
Reason for Suspension*
If applicable, please attach proof of medical certificate

Browse Files

Cancelof
I agree to Terms and Conditions*

I, the undersigned, request to suspend my membership for the time frame above as per the terms of my Direct Debit Request (DDR) and Contract. I understand that I can suspend my membership at $5.00 per week for a maximum of 6 weeks. I understand that if my account is in overdue status, I must arrange to pay all monies owing before a suspension can be processed. I consider my membership to be suspended for the dates i have requested unless i am notified otherwise from the customer care team via email. I understand that i need to give 3 days notice to suspend my membership to avoid future payments being deducted.
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