FitKloud – Sociallity Members

Select Access*

Total Due Today

$0.00

Member Name*

First Last

Mailing Address*

Street Address City State ZIP Code

Email Address

Telephone Number*

Gender*

Date of Birth*

Payment Information*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Terms and Conditions*

Customer authorizes Sociallity to charge their credit card or debit card the amount due for this program access activation
Customer authorizes Sociallity to automatically charge their credit card or debit card the monthly access fees. Customer understands that this charge will automatically be made until such a time that Customer elects to cancel their access.
Customer acknowledges and understands that they may cancel the program access at any time without penalty. Upon canceling their access, Sociallity will immediately discontinue charging the monthly access fee.
Customer acknowledges, agrees to, and accepts the Sociallity Privacy Policy, the Sociallity Website Use Terms and Conditions, the Sociallity AccessNow Terms and Conditions, and the Sociallity Healthcare Coin Terms and Conditions.
Customer acknowledges that they understand that none of the programs or services made available to them by Sociallity are Insurance products. The Sociallity AccessNow Program is designed to help manage out-of-pocket and self-pay deductible expenses and are in no way to be considered Insurance.