Common use of DEFAULT AND LATE PAYMENTS Clause in Contracts

DEFAULT AND LATE PAYMENTS. Should you default on any payment obligation as called for in this agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. A default occurs when any payment due under this agreement is more than ten days late. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN TEN DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. AN ADDITIONAL SERVICE FEE WILL BE CHARGED FOR ANY CHECK, DRAFT, CREDIT CARD, OR ORDER RETURNED FOR INSUFFICIENT FUNDS OR ANY OTHER REASON. If the Member is paying monthly dues by electronic funds transfer (EFT), the club reserves the right to draft via EFT all amounts owed by the member including any and all late fees and service fees. Subject to appropriate State and Federal Law. Note: Members paying monthly dues by EFT are subject to $5.00 per month increase of monthly dues if EFT payment is stopped or changed. This will not affect any other provisions of this agreement. 1st Pay Schedule: DUES 2nd Pay Schedule: DUES Notwithstanding any other provisions of this Agreement, you understand and agree that the amount of your monthly membership dues is based on current sales tax rates and to the extent such rates should increase during your membership, the club has the right to increase your monthly membership dues by the amount of such increase. If you have requested the privilege of paying monthly dues by pre-authorized electronic funds transfer, the monthly amount so transferred will be adjusted to reflect any increase in the sales tax rate. Notice: Any holder of this agreement is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof, recovery hereunder by Club Representative Member Parent or Guardian Number of Payments Monthly Payment Amounts Payment Due Dates $ Request for Preauthorized Payment Please Attach a Void or Blank Check – Required for All EFT and Credit Card Draft Accounts I/We hereby authorize Texas Sports Medicine Center, 00000 Xxxxxxx Xxxxxxx, Xxxxxxx, XX 00000 to bill my (Member) account and further authorize the Company to draw items (checks, electronic fund transfers, charge card) for the purpose of paying said payments, including any late fees or service fees, on the account of . Payment Method: Bank Name Routing Number (9 Digits) Account Number Account Type Account Owner Card Type Account Number Expiration M/Y Card Owner Subject to the following conditions:

DEFAULT AND LATE PAYMENTS. Should you default on any payment obligation as called for in this agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. A default occurs when any payment due under this agreement is more than ten days late. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN TEN DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEEFEE IN THE AMOUNT OF $10 (TEN DOLLARS). THE CENTER RESERVES THE RIGHT TO INCREASE THE LATE FEE ONCE ANNUALLY, WITH SUCH INCREASE NOT TO EXCEED AN ADDITIONAL SERVICE FEE WILL BE CHARGED FOR ANY CHECK, DRAFT, CREDIT CARD, OR ORDER RETURNED FOR INSUFFICIENT FUNDS OR ANY OTHER REASON$2 (TWO DOLLARS). If the Member is paying monthly bi-weekly dues by electronic funds transfer (EFT), the club club’s billing company, ABC Financial Services, LLC, reserves the right to draft via EFT all amounts owed by the member including any and all late fees and service fees. Subject to appropriate State and Federal Law. Note: Members paying monthly dues by EFT are subject to $5.00 per month increase of monthly dues if EFT payment is stopped or changed. This will not affect any other provisions of this agreement. 1st Pay Schedule: DUES 2nd Pay Schedule: DUES Notwithstanding any other provisions of this Agreement, you understand and agree that the amount of your monthly bi-weekly membership dues is based on current sales tax rates and to the extent such rates should increase during your membership, the club has the right to increase your monthly bi-weekly membership dues by the amount of such increase. If you have requested the privilege of paying monthly your bi-weekly dues by pre-authorized electronic funds transfer, the monthly bi-weekly amount so transferred will be adjusted to reflect any increase in the sales tax rate. Notice1st Pay. Schedule: Any holder DUES Number of Payments Bi-Weekly Payment Amount First Bi-Weekly Payment Due Date $ 2nd Pay. Schedule: Number of Payments Bi-Weekly Payment Amount First Bi-Weekly Payment Due Date $ NOTICE: ANY HOLDER OF THIS AGREEMENT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT HERETO OR WITH THE PROCEEDS HEREOF, RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER. CONSUMER’S RIGHT TO CANCELLATION. YOU MAY CANCEL THIS CONTRACT WITHOUT ANY PENALTY OR FURTHER OBLIGATION BY CAUSING A WRITTEN NOTICE OF YOUR CANCELLATION TO BE DELIVERED IN PERSON OR POSTMARKED BY CERTIFIED OR REGISTERED UNITED STATES MAIL WITHIN THREE (3) BUSINESS DAYS OF THE DATE OF THIS CONTRACT OR THE DATE OF YOUR RECEIPT TO THE ADDRESS SPECIFIED IN THIS CONTRACT. NOTICE TO BUYER: DO NOT AGREE TO THE TERMS OF THIS CONTRACT UNLESS YOU HAVE READ AND UNDERSTOOD IT IN ITS ENTIRETY. By signing below, the Member warrants that he/she has read, understood, and knowingly accepts the terms and conditions of this agreement is subject to all claims and defenses agreement. Member warrants that no agent, servant or employee of the Center has made any representations or promises upon which the debtor could assert against member relied in signing this agreement. The Member warrants that he/she is over the seller age of goods 18 and is not incapacitated or services obtained pursuant hereto or with incompetent. The Member warrants that it is his/her express intent to be bound by the proceeds hereofterms and conditions of this contract, recovery hereunder in consideration for the membership rights afforded by Club Representative this contract. Member Signature: IF MEMBER IS UNDER THE AGE OF 18, Parent or Guardian Number of Payments Monthly Payment Amounts Payment Due Dates $ Request for Preauthorized Payment Please Attach a Void or Blank Check – Required for All EFT and Credit Card Draft Accounts Signature: MEMBER IF MEMBER IS UNDER THE AGE OF 18, PARENT OR GUARDIAN REQUEST FOR PREAUTHORIZED PAYMENT PLEASE ATTACH A VOID OR BLANK CHECK I/We hereby authorize Texas Sports Medicine Centerrequest the privilege of paying to ABC Financial Services, 00000 Xxxxxxx XxxxxxxLLC (“The Company”), XxxxxxxXxxxxxxx, XX 00000 to bill my (Member) account 00000, and further authorize the Company to draw items (checks, electronic fund transfers, charge card) for the purpose of paying said payments, including any late fees or service fees, on the account of . of: Payment Method: Bank Name Routing Number REQUIRED FOR ALL EFT AND CREDIT CARD DRAFT ACCOUNTS BANK NAME ROUTING NUMBER (9 DigitsDIGITS) Account Number Account Type Account Owner Card Type Account Number Expiration M/Y Card Owner ACCOUNT NUMBER ACCOUNT TYPE ACCOUNT OWNER CARD TYPE Subject to the following conditions:: ACCOUNT NUMBER EXPIRATION M/Y CARD OWNER

DEFAULT AND LATE PAYMENTS. Should you default on any payment obligation as called for in this agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. A default occurs when any payment due under this agreement is more than ten seven days late. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN TEN DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. AN ADDITIONAL SERVICE FEE WILL BE CHARGED IMMEDIATELY FOR ANY CHECK, DRAFT, CREDIT CARD, OR ORDER RETURNED FOR INSUFFICIENT INSUF- FICIENT FUNDS OR ANY OTHER REASON. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN SEVEN DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. If the Member is paying monthly dues by electronic funds transfer (EFT), the club club’s billing company, ABC Financial Services, Inc., reserves the right to draft via EFT all amounts owed by the member including any and all late fees and service fees. Subject to appropriate ap- propriate State and Federal Law. NoteAUTOMATIC RENEWAL PROGRAM: Members paying monthly dues by EFT are Provided that Member is not in default of this agreement and subject to $5.00 the terms and conditions hereof, the membership will automatically renew for the rate indicated below. Renewal terms may be cancelled at any time provided a 10-day written notice is delivered to the club’s address. It is also understood that the club has the option to increase monthly renewal dues without notice during any renewal period not to exceed the indicated amount per month increase month. TOTAL AMOUNT: INDICATED AMOUNT PER MONTH FOR FUTURE AUTOMATIC RENEWAL. NONRENEWABLE MEMBERSHIP: This membership will expire on the indi- cated date. Your first scheduled annual fee (AMF) of monthly dues if EFT payment indicated amount will be billed 60 days from begin date. The second scheduled AMF is stopped or changeddue 1 year from begin date and will recur on the same date each year thereafter. This will does not affect any other provisions of this agreementapply to Paid In Full options. 1st Pay Schedule: DUES 2nd Pay Schedule: DUES Notwithstanding any other provisions of this Agreement, you understand and agree that the amount of your monthly membership dues is based on current sales tax rates and to the extent such rates should increase during your membership, the club has the right to increase your monthly membership mem- bership dues by the amount of such increase. If you have requested the privilege of paying your monthly dues by pre-authorized electronic funds transfer, the monthly amount so transferred will be adjusted to reflect any increase in the sales tax rate. Notice: Any holder of this agreement is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof, recovery hereunder by Club Representative Member Parent or Guardian Number of Payments Monthly Payment Amounts Payment Due Dates $ Request for Preauthorized Payment Please Attach a Void or Blank Check – Required for All EFT and Credit Card Draft Accounts I/We hereby authorize Texas Sports Medicine Center, 00000 Xxxxxxx Xxxxxxx, Xxxxxxx, XX 00000 to bill my (Member) account and further authorize the Company to draw items (checks, electronic fund transfers, charge card) for the purpose of paying said payments, including any late fees or service fees, on the account of . Payment Method: Bank Name Routing Number (9 Digits) Account Number Account Type Account Owner Card Type Account Number Expiration M/Y Card Owner Subject to the following conditions:.

DEFAULT AND LATE PAYMENTS. Should you default on any payment obligation as called for in this agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. A default occurs when any payment due under this agreement is more than ten days late. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN TEN DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. AN ADDITIONAL SERVICE FEE WILL BE CHARGED IMMEDIATELY FOR ANY CHECK, DRAFT, CREDIT CARD, OR ORDER RETURNED FOR INSUFFICIENT FUNDS OR ANY OTHER REASON. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN THREE DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. If the Member is paying monthly dues by electronic funds transfer (EFT), the club club’s billing company, ABC Fitness Solutions, LLC, reserves the right to draft via EFT all amounts owed by the member including any and all late fees and service fees. Subject to appropriate State and Federal Law. NoteNOTE: Members paying monthly dues by EFT E.F.T. are subject to $5.00 10.00 per month increase of monthly dues if EFT E.F.T. payment is stopped or changed. This will not affect any other provisions of this agreement. 1st Pay ScheduleRENEWAL PROGRAM OPTIONS: DUES 2nd Pay ScheduleAUTOMATIC RENEWAL PROGRAM: DUES Provided that Member is not in default of this agreement and subject to the terms and conditions hereof, the membership will automatically renew for the rate indicated below. Renewal terms may be cancelled at any time provided a 10-day written notice is delivered to the club’s address. It is also understood that the club has the option to increase monthly renewal dues without notice during any renewal period not to exceed the indicated amount per month. TOTAL AMOUNT: INDICATED AMOUNT PER MONTH FOR FUTURE AUTOMATIC RENEWAL. NONRENEWABLE MEMBERSHIP: This membership will expire on the indicated date. An annual Club Enhancement fee of the indicated amount will be billed 60 days from begin date. The second schedule is due 1 year after begin date and will recur on the same date each year thereafter. Notwithstanding any other provisions of this Agreement, you understand and agree that the amount of your monthly membership dues is based on current sales tax rates and to the extent such rates should increase during your membership, the club has the right to increase your monthly membership dues by the amount of such increase. If you have requested the privilege of paying your monthly dues by pre-pre- authorized electronic funds transfer, the monthly amount so transferred will be adjusted to reflect any increase in the sales tax rate. Notice: Any holder of this agreement is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof, recovery hereunder by Club Representative Member Parent or Guardian Number of Payments Monthly Payment Amounts Payment Due Dates $ Request for Preauthorized Payment Please Attach a Void or Blank Check – Required for All EFT and Credit Card Draft Accounts I/We hereby authorize Texas Sports Medicine Center, 00000 Xxxxxxx Xxxxxxx, Xxxxxxx, XX 00000 to bill my (Member) account and further authorize the Company to draw items (checks, electronic fund transfers, charge card) for the purpose of paying said payments, including any late fees or service fees, on the account of . Payment Method: Bank Name Routing Number (9 Digits) Account Number Account Type Account Owner Card Type Account Number Expiration M/Y Card Owner Subject to the following conditions:.

DEFAULT AND LATE PAYMENTS. Should you default on any payment obligation as called for in this agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. A default occurs when any payment due under this agreement is more than ten days late. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN TEN DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. AN ADDITIONAL SERVICE FEE WILL BE CHARGED IMMEDIATELY FOR ANY CHECK, DRAFT, CREDIT CARD, OR ORDER RETURNED FOR INSUFFICIENT FUNDS OR ANY OTHER REASON. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN THREE DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. If the Member is paying monthly dues by electronic funds transfer (EFT), the club club’s billing company, ABC Financial Services, LLC, reserves the right to draft via EFT all amounts owed by the member including any and all late fees and service fees. Subject to appropriate State and Federal Law. NoteNOTE: Members paying monthly dues by EFT E.F.T. are subject to $5.00 10.00 per month increase of monthly dues if EFT E.F.T. payment is stopped or changed. This will not affect any other provisions of this agreement. 1st Pay ScheduleRENEWAL PROGRAM OPTIONS: DUES 2nd Pay ScheduleAUTOMATIC RENEWAL PROGRAM: DUES Provided that Member is not in default of this agreement and subject to the terms and conditions hereof, the membership will automatically renew for the rate indicated below. Renewal terms may be cancelled at any time provided a 10-day written notice is delivered to the club’s address. It is also understood that the club has the option to increase monthly renewal dues without notice during any renewal period not to exceed the indicated amount per month. TOTAL AMOUNT: INDICATED AMOUNT PER MONTH FOR FUTURE AUTOMATIC RENEWAL. NONRENEWABLE MEMBERSHIP: This membership will expire on the indicated date. An annual Club Enhancement fee of the indicated amount will be billed 60 days from begin date. The second schedule is due 1 year after begin date and will recur on the same date each year thereafter. Notwithstanding any other provisions of this Agreement, you understand and agree that the amount of your monthly membership dues is based on current sales tax rates and to the extent such rates should increase during your membership, the club has the right to increase your monthly membership dues by the amount of such increase. If you have requested the privilege of paying your monthly dues by pre-authorized electronic funds transfer, the monthly amount so transferred will be adjusted to reflect any increase in the sales tax rate. Notice: Any holder of this agreement is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof, recovery hereunder by Club Representative Member Parent or Guardian Number of Payments Monthly Payment Amounts Payment Due Dates $ Request for Preauthorized Payment Please Attach a Void or Blank Check – Required for All EFT and Credit Card Draft Accounts I/We hereby authorize Texas Sports Medicine Center, 00000 Xxxxxxx Xxxxxxx, Xxxxxxx, XX 00000 to bill my (Member) account and further authorize the Company to draw items (checks, electronic fund transfers, charge card) for the purpose of paying said payments, including any late fees or service fees, on the account of . Payment Method: Bank Name Routing Number (9 Digits) Account Number Account Type Account Owner Card Type Account Number Expiration M/Y Card Owner Subject to the following conditions:.

DEFAULT AND LATE PAYMENTS. Should you default on any payment obligation as called for in this agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. A default occurs when any payment due under this agreement is more than ten days late. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN TEN DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. AN ADDITIONAL SERVICE FEE WILL BE CHARGED IMMEDIATELY FOR ANY CHECK, DRAFT, CREDIT CARD, OR ORDER RETURNED FOR INSUFFICIENT FUNDS OR ANY OTHER REASON. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN THREE DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. If the Member is paying monthly dues by electronic funds transfer (EFT), the club club’s billing company, ABC Financial Services, LLC, reserves the right to draft via EFT all amounts owed by the member including any and all late fees and service fees. Subject to appropriate ap- propriate State and Federal Law. NoteNOTE: Members paying monthly dues by EFT E.F.T. are subject to $5.00 10.00 per month increase of monthly dues if EFT E.F.T. payment is stopped or changed. This will not affect any other provisions of this agreement. 1st Pay ScheduleRENEWAL PROGRAM OPTIONS: DUES 2nd Pay ScheduleAUTOMATIC RENEWAL PROGRAM: DUES Provided that Member is not in default of this agreement and subject to the terms and conditions hereof, the membership will automatically renew for the rate indicated below. Renewal terms may be cancelled at any time provided a 10-day written notice is delivered to the club’s address. It is also understood that the club has the option to increase monthly renewal dues without notice during any renewal period not to exceed the indicated amount per month. TOTAL AMOUNT: INDICATED AMOUNT PER MONTH FOR FUTURE AUTOMATIC RENEWAL. NONRENEWABLE MEMBERSHIP: This membership will expire on the indicated date. An annual Club Enhancement fee of the indicated amount will be billed 60 days from begin date and on the same date each year thereafter. Notwithstanding any other provisions of this Agreement, you understand and agree that the amount of your monthly membership dues is based on current sales tax rates and to the extent such rates should increase during your membership, the club has the right to increase your monthly membership dues by the amount of such increase. If you have requested the privilege of paying your monthly dues by pre-authorized electronic funds transfer, the monthly amount so transferred will be adjusted to reflect any increase in the sales tax rate. Notice: Any holder Member affirms, acknowledges and attests that Member’s mailing address, telephone number, and e-mail address provided on the face of this agreement is subject are accurate and were provided by Member voluntarily. Subject to all claims applicable law, Member agrees that Crunch Pacific Beach and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereofABC Financial Services, recovery hereunder by Club Representative Member Parent or Guardian Number of Payments Monthly Payment Amounts Payment Due Dates $ Request for Preauthorized Payment Please Attach a Void or Blank Check – Required for All EFT and Credit Card Draft Accounts I/We hereby authorize Texas Sports Medicine Center, 00000 Xxxxxxx Xxxxxxx, Xxxxxxx, XX 00000 to bill my (Member) account and further authorize the Company to draw items (checks, electronic fund transfers, charge card) for the purpose of paying said paymentsLLC, including its agents and affiliates, may contact Member at any late fees mailing address, phone number or service fees, e-mail ad- dress set forth on the account face of . Payment Methodthis agreement, or subsequently provided by Member to Crunch Pacific Beach and/or ABC Financial Services, Inc. NOTICE: Bank Name Routing Number (9 Digits) Account Number Account Type Account Owner Card Type Account Number Expiration M/Y Card Owner Subject to the following conditions:ANY HOLDER OF THIS AGREEMENT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT HERETO OR WITH THE PRO- CEEDS HEREOF, RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EX- CEED AMOUNTS PAID BY THE DEBTOR HEREUNDER.

DEFAULT AND LATE PAYMENTS. Should you default on any payment obligation obliga- tion as called for in this agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. A default occurs when any payment due under this agreement is more than ten days late. A SERVICE FEE WILL BE CHARGED IMMEDIATELY FOR ANY CHECK, DRAFT, CREDIT CARD, OR ORDER RETURNED FOR INSUFFICIENT FUNDS OR ANY OTHER REASON. SHOULD ANY MONTHLY PAYMENT BECOME MORE THAN TEN DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. AN ADDITIONAL SERVICE FEE WILL BE CHARGED FOR ANY CHECK, DRAFT, CREDIT CARD, OR ORDER RETURNED FOR INSUFFICIENT FUNDS OR ANY OTHER REASON. If the Member is paying monthly dues by electronic funds transfer (EFT), the club club’s billing company, ABC Financial Services, Inc., reserves the right to draft via EFT all amounts owed by the member including any and all late fees and service fees. Subject to appropriate ap- propriate State and Federal Law. NoteNOTE: Members paying monthly dues by EFT E.F.T. are subject to $5.00 10.00 per month increase of monthly dues if EFT E.F.T. payment is stopped or changed. This will not affect any other provisions of this agreement. 1st Pay SchedulePay. Schedule : DUES 2nd Pay Schedule: DUES Notwithstanding any other provisions of this Agreement, you understand and agree that the amount of your monthly membership dues is based on current sales tax rates and to the extent such rates should increase during your membership, the club has the right to increase your monthly membership dues by the amount of such increase. If you have requested the privilege of paying monthly dues by pre-authorized electronic funds transfer, the monthly amount so transferred will be adjusted to reflect any increase in the sales tax rate. Notice: Any holder of this agreement is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof, recovery hereunder by Club Representative Member Parent or Guardian Number of Payments Monthly Payment Amounts Amount Payment Due Dates Date $ Request for Preauthorized 2nd Pay. Schedule : Number of Payments Monthly Payment Please Attach a Void or Blank Check – Required for All EFT and Credit Card Draft Accounts Amount Payment Due Date $ NOTICE: ANY HOLDER OF THIS AGREEMENT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OB- TAINED PURSUANT HERETO OR WITH THE PROCEEDS HEREOF, RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER. CLUB REPRESENTATIVE MEMBER PARENT OR GUARDIAN REQUEST FOR PREAUTHORIZED PAYMENT I/We hereby authorize Texas Sports Medicine Centerrequest the privilege of paying to ABC Financial Services, 00000 Xxxxxxx XxxxxxxInc (“The Company”), XxxxxxxSherwood, XX 00000 to bill my (Member) account AR 72124, and further authorize the Company to draw items (checks, electronic fund transfers, charge card) for the purpose of paying said payments, including any late fees or service fees, on the account of . REQUIRED FOR ALL EFT AND CREDIT CARD DRAFT ACCOUNTS Payment Method: Bank Name Routing Number BANK NAME ROUTING NUMBER (9 DigitsDIGITS) Account Number Account Type Account Owner Card Type Account Number Expiration ACCOUNT NUMBER ACCOUNT TYPE ACCOUNT OWNER CARD TYPE ACCOUNT NUMBER EXPIRATION M/Y Card Owner CARD OWNER Subject to the following conditions: