Schedule your payments to be automatically charged to your credit card. Just complete and sign this form to get started! Member Name: Date: Phone: email: Membership start date: / /_ Elite Clients Monthly Memberships: (1st or 15th of each month) Share your membership with any household member. 15% on all other services costing $100 or more Unused massage sessions roll-over or give unused sessions to family member. Select payment type below: Credit or Debit Card: Visa MasterCard Discover American Express Please select your wellness membership type: ******************************************************************* Massage $79 ******************************************************************* Laser Hair Removal* SM $59.99/Monthly (lip, chin, underarm or sideburns) MED $79.99/Monthly (Brazilian, lip & chin) LG $99.99/Monthly (1/2 leg or arm, upper or lower back) X- LG $129.99/Monthly (full back, full legs , full arms) *requires deposit equaling 2months based on area/size ******************************************************************* CRYO T-Shock $149/Monthly* Face Lift, Neck or Decollete $179/Monthly* Fat Freeze/Cellulite/ Tighten & Tone Credit Card # Expiration: CVV Code: Billing Zip Name as it appears on card I authorize my credit card to be charged; Signature: Cancellation: To cancel this agreement; cancellation must be made in writing 30 days prior to cancellation. Initials: Terms & Conditions: Not valid with any other offers; 24hrs appointment cancellation notice required (see spa policies). May be shared with any person within your household. Initials: By signing below, I agree to the membership type and payment type selected. I authorize Spa Boutique 2go llc to process credit card transactions from my account. Applicants agree that all information provided is accurate and complete. Applicants understand there is a six-month minimum participation requirement. If canceled prior to the six month time limit, then all accrued charges will be adjusted to the standard cash rates which are higher. Upon cancellation, unused services will be forfeited. Membership can be suspended for no more than 60 days during which time member benefits cannot be used. Applicants acknowledge that all orders may be immediately terminated at Spa Boutique’s discretion if charges are declined and remain unresolved for 30 days or charge backs are claimed against any outstanding invoiced amount … all unused benefits will expire immediately. Disputes should be immediately reported to us at 212-234-4769. Changes in card status can also be reported at this number. Note: a $10 fee will be applied for each credit card denial. It is up to the member to maintain account balances and current credit card information Initials: I understand that this authority will remain in effect until I follow the cancellation procedure set forth above. Member Signature: Date:
Membership for One X-Large Area $109.99 o Option II – No deposit - 1st treatment scheduled after second months payment is made.
Membership for One X-Large Area o Option I – Deposit $219.98
Membership for One Small Area $49.99 o Option II – No deposit - 1st treatment scheduled after second months payment is made.
Membership for One Small Area o Option I – Deposit $99.88
Membership for One Medium Area $69.99 o Option II – No deposit - 1st treatment scheduled after second months payment is made.
Membership for One Medium Area $69.99 o Option I – Deposit $139.98
Membership for One Large Area $89.99 o Option II – No deposit - 1st treatment scheduled after second months payment is made.
Membership for One Large Area o Option I – Deposit $179.98
$69 60Min Monthly Massage
$79 60Min Monthly Massage
60 min monthly massage