Hold Account Form

Hold Account Form
Name*

First NameLast Name
Family Auto, list other names on account:
Email*
example@example.com
Phone Number*

Area CodePhone Number
Today's Date*

MonthDayYear
Date
Duration of Hold

1 billing cycle (1 month)2 billing cycles (2 months)3 billing cycles (3 months)
Reason for hold
To ensure adequate time for processing, Hold Form must be completed and signed at least 5 days before billing date. Hold forms received after the deadline will be processed the following billing cycle, and the client's account will be charged on the next billing date as usual.

While account is on hold, client may purchase Drop-In classes at discounted rate of $15 per class
Signature

Clear
Enter the message as it's shown*
Thank you for your patronage. If you have any questions, do not hesitate to call the studio at (210) 569-0611 or e-mail Mark Banasau at mark@theunionsa.com.
Form update: 5/1/19
Should be Empty: