Advanta Provider Relations

Provider Application

Form Date: 3/2/2025

Your Name *

Title *

Facility Name *

Email Address *

Phone Number *

Do you have more than 1 location? *YesNo

Facility address

Street *

City *

State *

Zip *

Corporate address

Street *

City *

State *

Zip *

Number of Locations you own or operate *

Are the facilities located in more than one state? *YesNo

Is your facility open to the general public? *YesNo

Does your company have a clean record with the Better Business Bureau? *YesNo

Is your facility registered/bonded with the state consumer affairs department? *YesNoNot Required

Do new members receive a complimentary fitness evaluation and/or program set up? *YesNo

Are you able to track and report membership usage data electronically? *YesNo

Which amenities are included as part of a standard membership? *

(double click on the amenity to select it)

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Group Exercise Classes
Aquatic Exercise
Basketball
Cardiovascular Equipment
Child Care
Co-Ed Fitness
Fitness Center
Group Cycling
Free Weights
Kick Boxing
Massage
Nutritional Counseling
Personal Training
Physical Therapy
ProShop
Pool - Indoor
Pool - Outdoor
Racquetball
Sauna
Squash
Steam Room
Tennis - Indoor
Tennis - Outdoor
Track - Indoor
Track - Outdoor
Whirlpool
Yoga

This information is for evaluation purposes and will be treated as confidential.

Email me a copy of the information I submitted on this form.