Gym Assistant Sign-up Form

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To speak with a sales rep
(724) 939-6591

Company Information

If you are a management company completing this application on behalf of a client, this information should be for your client's business.


* The legal name is the name that was registered with the secretary of state
Name that the business operates under that isn't its legal business name
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Do you have a website?

* Enter your website, Facebook, Instagram, YouTube or other social media platform page.

Address


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Do you have a separate mailing address?

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Primary Contact

Person we can contact to ask questions regarding this application or ACH processing issues once your account is live.


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Billing Contacts

Monthly invoices will be sent to the email addresses provided below.


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Beneficial Owner Information

If no single owner has 25% or more equity, please identify the managing partner or executive.


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Transaction Information

The information below should reflect what you think your activity will look like in about 6 to 12 months.


How will you receive authorization from your customers to process payments via ACH? (Select all that apply) *

What type of payments do you want to process via ACH? (Select all that apply) *

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Bank Information


Please provide information for the bank account to use for processing your payments.

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Do you want us to bill a separate bank account?

Please provide information for the bank account to use for your billing.

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