HBA Monthly Member
REGISTRATION
541 Division St. Building B Campbell, CA 95008
OFFICE: (408) 866-8050 FAX: (408) 866-8088
OFFICE: (408) 866-8050 FAX: (408) 866-8088Contact Information
Name:
Address:
City:
ZIP:
Home Phone:
Date of Birth:
Email Address:
Cell Phone:
Payment Information
Amount:
Credit Card Number:
Exp. Date:
Name On Card:
ZIP:
Billing Address:
CVV Code (back of card):
Payment Schedule- ALL PAYMENTS WILL BE AUTOMATICALLY CHARGED VIA CREDIT/DEBIT CARD ON FILE . YOU CAN CALL OUR OFFICE TO GIVE YOUR CREDIT CARD INFO.
Monthly COST: (paid 1 month at a time via your credit/debit card)
NO REFUNDS FOR ANY REASON!!!
Monthly Member Club Cost:
Monthly Fee........................................................................................................$10.00.**
Sign-up Fee (waived for the first month of membership).....................$ 9.95.***
**You must give a 60 day notice to cancel your membership and be a member for a minimum of 3 months. You Member fee is guaranteed for 12 months.
***This fee is waived the first month of being in the program. If you start then stop and then restart your membership the sign-up fee will apply.
(Please make sure to fill out credit card information).
YOU NEED TO AGREE TO THE MONTHLY FEE TERMS BELOW TO BE IN THE MONTHLY MEMBER PROGRAM.
LAST STEP IS VERY IMPORTANT!!!!
