Head of Household *

First Name

Last Name

Phone

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Acceptance Agreement *

By proceeding, you acknowledge and agree to the following: I hereby authorize GripSpin Tennis to request and review a copy of my most recent federal tax return for the sole purpose of verifying my stated income. I understand this information will be kept confidential and used exclusively for determining your eligibility for the Affordable Rate Program. I further agree to provide GripSpin Tennis with the necessary documentation and information to facilitate this verification process, which may include, but is not limited to, my Social Security Number (SSN) or Taxpayer Identification Number (TIN) and a signed consent form for the release of tax information. I understand that my refusal to provide this information or any discrepancy found during the income verification process may result in an immediate cancellation of service in the program and may result in your information being turn over to the proper authorities. This agreement is valid for the duration of my application/participation in Affordable Rate Program with GripSpin Tennis.

I agree to the terms and conditions outlined above.