ELITE Automated Clearing House (ACH)

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Correo electrónico *

Mobile Phone Number: *

Name on Account: *

Account Routing Number: (must have exactly 9 digits): *

Account Number: *

Account Type *

Checking

Savings

Obligatoria

What is your preferred billing date (Effective Date): *

1st day of the Month

16th day of the Month

What membership are you enrolling for: *

Tiny Diamonds Jiu-Jitsu (ages 3 & 4)

Youth Jiu-Jitsu (ages 5 and up)

Adult Jiu-Jitsu

Women's Jiu-Jitsu

Brave Jiu-Jitsu (Brave Membership)

Brave Jiu-Jitsu (Athlete Sponsor)

How many classes per week are you attending (enrolling): *

1 class/week

2 classes/week

3 classes/week

4 or more classes/week (unlimited training)

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