Health Club Direct Debit Suspension Application Request Form

Direct Debit Suspension Application Request Form
Select your centre*
Please note that if you will be away, the suspension period must commence on the Thursday preceding your missed lessons and conclude on the Wednesday of the week you return.
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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