Payment Information ☐ ☐ Payment Frequency: Yearly Monthly ☐ ☐ ☐ Payment Method: Cash Check Credit Card ☐Visa ☐Master ☐Discover ☐American Card Type: Card Express Credit Card Information: ________________________________________________ Name on Card ________________________________________________ Number ________________________________________________ Date of Expiration Security Code ________________________________________________ Signature of Card Holder
Payment Information Payment Frequency: ☐ Yearly ☐ Monthly Payment Method: ☐ Cash ☐ Check ☐ Credit Card Card Type: ☐Visa ☐Master Card ☐Discover ☐American Express Credit Card Information: ________________________________________________ Name on Card ________________________________________________ Number ________________________________________________ Date of Expiration Security Code ________________________________________________ Signature of Card Holder
VitV-Membership-Application.docx