Membership Information Change Form

MEMBER INFORMATION

First Name *

Last Name *

Email Address *

Member Number *

What is your current membership type: *

What would you like to change *

Contact Information (Email, Phone Number, Billing Address, Emergency Contact)

Payment Type for Membership Account or House Account

Changing Your Membership Category (In Effect January 1st, 2024)

Please note that changes will be made within 3-5 business days.

Contact Information

Email Address (If Changing)

Phone Number

Street Address

City

Province

Postal Code

Emergency Contact Information

First Name

Last Name

Phone Number

Payment

Payment Terms and Method

Are you changing your payment type for *

Membership Account

House Account

Payment Method *

Credit Card

Direct Withdrawal (PAP)

Please note that there will be a 3% credit card fee.

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVC *

Name on Account *

Bank Name *

Transit No. *

Institution No. *

Account No. *

Upload a void cheque:

Sample Void Cheque

*The Member hereby agrees to provide Greenhills Valley Holdings Limited with a valid Credit Card (VISA, MC, or American Express) account number. The Member hereby authorizes Greenhills to charge the credit card with any amounts owing to Greenhills which are not paid by the due date. *I authorize that my House Account charges, Monthly Dues and Membership Fees will be processed to my credit card on each appropriate due date. If any settlement is declined by the card centre, I have two business days grace to ensure that the amount owing plus a $25 administration fee is paid, otherwise late payment charges will be incurred. *

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Catagory Change

Please note that if you wish to change to a different category and there is a waitlist, we will confirm that you have been accepted on the waitlist.

I would like to change my category from: *

I would like to change my category to: *