Ezidebit Exit Form
PLEASE NOTE: Payments are direct debited approximately 1-2 weeks prior to the start of each term.
Exit forms must be received prior to the following dates (please indicate which term you are exiting from):
**IMPORTANT: Any forms received after these dates will apply to the next term
Select a location
Required
Gymnast First Name
Your answer
Gymnast Surname
Your answer
Parent Name
Your answer
Contact Number
Your answer
Please list class/s wishing to exit from (e.g. Mon L3-6 4pm – 7pm)
Your answer
Reason for exiting
Your answer
I wish to exit my Direct Debit arrangement with Ezidebit / Le Ray Gymnastics
Required
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