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New Tanning Membership
Step 1. New Member Information
New Member Name:
First Name
Last Name
MM
DD
YYYY
ID Verify
SSN / DL#
Gender
Male/Female
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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New Member Information Continued
Cell Number
Work Number
E-mail
Email Address
Age:16 years or older?
Yes
No
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Step 2. Member Payment Information
Draft Account Owner Name:
First Name
Last Name
Credit Card#
Expiration:
MM/YY
CVV Code
3 digit
Card Type:
*
Please Select
Visa
Mastercard
Discover
Amex
Other
I Agree, and give AUTHORIZATION FOR PREAUTHORIZED PAYMENTS. I/We hereby authorize the Designated Billing Company selected by Sunbright Tanning to draw items (checks, electronic fund transfers, charge card) for the purpose of paying the membership dues, including any late fees or service fees, as well as other purchases, on the account indicated below.
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New Member Payment Information Continued
<span style="color: #ffffff; font-size: medium;"><strong><span style="color: #99cc00;">NOTICE: </span>Providing a backup credit card will WAIVE the $1.29 processing fee.</strong></span>
Backup Credit Card#
Expiration:
MM/YY
CVV Code
3 digit
Card Type:
Please Select
Visa
Mastercard
Discover
Amex
Other
Backup Credit Card:
Secondary
Decline
Is the New Member also the CC Account Holder?
YES
NO
ALMOST DONE!
PLEASE SEE A STAFF MEMBER TO COMPLETE THE LAST STEP.
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Staff Member (Last Step!)
Membership Summary
Member Level:
*
Please Select
Diamond
Platinum
Gold
Silver
Member Start Date (Today):
First Scheduled Draft Date:
Member Term:
*
Please Select
Month to Month
6 Month
12 Month
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Membership Summary Continued
Down Payment (Paid Today)
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( X )
Enrollment
$
9.50
Membership Level
$
24.99
Member Level
Silver
Gold
Platinum
Diamond
Term
$
Free
Member Term
Month to Month
6 Months ($0 Enroll)
12 Months ($0 Enroll & Free Bottle)
Enter coupon
Apply
Total
$
0.00
Payment Summary
Down Payment:
Total $ In Box Above
Dues Rate:
$ Per EFT Payment
CC Processing:
$ Per EFT Payment
Taxes:
$ Per EFT Payment
Monthly Draft:
$ Per EFT Payment
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Final Signature Page
Signature Date:
-
Month
-
Day
Year
Date Picker Icon
Staff Member
Please Select
Kelsey Cook
Ashley Theising
Emily Daugherty
Lindsay Schultz
Britney Cangemi
Loren Johnson
Lauren Hull
Manassas Park | <b>703.369.9911</b>
Member Signature:
*
I Agree, to terms & conditions, received a copy and I consent use of my electronic signature in lieu of a paper signature.
I Agree,and understand that AUTO RENEWAL Member dues will automatically renew at the end each monthly billing cycle. Renewal Terms maybe cancelled at any time with a 30 day written notice delivered directly to the club.
Draft Account Owner Signature:
Parental Consent
PARENTAL CONSENT. I hereby give my permission as parent OR legal guardian of the new client referenced above, my authorization to tan at this facility. I have read and fully understand this Client Release and Informed Consent Form and hereby agree to accept all of the provisions.
Print Guardian First & Last Name
Submit
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