ELITE Automated Clearing House (ACH)
Mobile Phone Number:
Name on Account:
Account Routing Number: (must have exactly 9 digits):
What is your preferred billing date (Effective Date):
1st day of the Month
16th day of the Month
What membership are you enrolling for:
Tiny Diamonds Jiu-Jitsu (ages 3 & 4)
Youth Jiu-Jitsu (ages 5 and up)
Brave Jiu-Jitsu (Brave Membership)
Brave Jiu-Jitsu (Athlete Sponsor)
How many classes per week are you attending (enrolling):
4 or more classes/week (unlimited training)
Send me a copy of my responses.
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service