Preventive Maintenance
Membership Form
Date: |
_____________________________________ |
Name: |
_____________________________________ |
Address: |
_____________________________________ |
City: |
_____________________________________ |
State: |
_____________________ |
Telephone: |
_________________________________ |
PROGRAM (CIRCLE PROGRAM CHOICE) |
|
| $99 BRONZE (FIRST DOOR) | |
| _____ ADDITIONAL DOORS | X $45 = ___________ |
| $109 SILVER (FIRST DOOR) | |
| _____ ADDITIONAL DOORS | X $40 = ___________ |
| $199 GOLD (FIRST DOOR) | |
| _____ ADDITIONAL DOORS | X $35 = ___________ |
| TOTAL: _____________ | |
| *We will preform preventive maintenance once we receive membership form and payment | |
| ________________ Enclosed is a check | |
| ________________ Call for credit card information | |
Return To: |
|