Jimmy's Gym sign-up

Please fill in your basic details below to start off your sign up with Jimmy’s Gym. Please note: items marked with * are required.

Name

Last Name

Contact Number

Email Address

Address 1

Address 2

City

Province/State

Country

Postal Code

Please enter the details of the bank account you will be charged from:

Bank Name

Branch Code

Abbreviated Name:

The customer abbreviated name as will appear on the statement

Account Number

Account Type

Action Day

Name on Statement

Contract Reference

Frequency

Start Date

Amount

Maximum Amount

Debit Escalations

Variable Amounts

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