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Customer Service Information


MEMBER BILLING INFORMATION CHANGE FORM

**Please note that we do not send monthly bills**

In order to keep your membership up to date, we require an account for your monthly billing. Please note that any payments that are not collected as scheduled are subject to a $5.50 service fee and a $10.00 or 5% late charge, whichever is greater. Please complete the form below and "Hit" the "Print" button on the bottom. Then print and fax the form along with the appropriate documents to (212) 734-9807 or mail to: Lucille Roberts Fitness Clubs, LR Customer Service Department, 1202 Lexington Avenue, Box 333, New York, NY 10028.

If you have any questions, please call our Customer Service Representatives at 212-734-9717, Monday thru Friday 9-12 pm and 1-4 pm.

Please Note: All forms must be FULLY COMPLETE and mailed or faxed along with the required documents or we cannot complete your request. No email or other forms of response will be accepted.

Sincerely,

Lucille Roberts Fitness Clubs
LR Customer Service Department

PAYER'S INFORMATION


Check here if you are paying for more than one member (You must complete one form per member).
Date:
Membership Number:
First Name:
Last Name:
Middle Name:
Home Phone Number:
Work Phone Number:
Address:
Apt. #:
City:
State:
Zip:
Club Location:
Type of Account: Credit Card Checking

CREDIT CARD ACCOUNT INFORMATION


Visa     MasterCard
American Express     Discover Card
Credit Card Account #:
Expiration Date:

CHECKING ACCOUNT INFORMATION


You must attach a signed VOID check. If you fail to do so, your request will not be processed.
ACH Number:
Routing Number:

PAYER'S AUTHORIZATION


I, authorize Lucille Roberts Fitness Clubs to debit my new checking/credit card account for any balance due and future payments for the above membership.
No applications can be accepted without a membership number and complete name. Print and fax this form along with the appropriate documents to (212) 734-9807 or mail to: Lucille Roberts Fitness Clubs, LR Customer Service Department, 1202 Lexington Avenue, Box 333, New York, NY 10028.


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