Latitude Membership

ACH Information for Direct Transfer of Membership Dues

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Name *

First

Last

Email *

Membership Selection *

Bank ROUTING Number *

Manually Re-Enter Bank ROUTING Number *

Bank ACCOUNT Number *

Manually Re-Enter Bank ACCOUNT Number *

Account Type *

Checking Savings

I authorize Latitude 44 Yoga Studio, LLC to transfer funds from my bank account to cover monthly expenses related to my membership dues as well as make any adjustments for any debit entry errors to my account. If funds are not available in my bank account, I authorize Latitude 44 Yoga Studio to utilize my credit card that is on file to cover these expenses. Latitude 44 Yoga Studio reserves the right to charge $10 per incident for any EFT reclear fee, unpaid EFT draft, declined credit or debit card, unpaid credit card chargeback, or late payment. [Electronic Signature] *

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