Membership Cancellation Form
30 Day Cancellation Notice: By checking this box and clicking the "Submit" button on this page, I acknowledge that the cancellation request can take up to 30 (thirty) days to be processed. I further acknowledge that if my next scheduled billing date is less than 30 days from the submission date of this form, I WILL be billed as per the terms outlined in my contract.
Type option 1
By checking the "Terms and Conditions" box and clicking the "Submit" button on this page, I understand that I authorize the processing of my membership at Halo Med Spa. I acknowledge that the above information is accurate and correct. Any misrepresentation with the current information are the sole responsibility of the undersigned. Furthermore, I understand that the cancellation of my membership will be executed as per the terms and time frame outlined in my membership agreement. I understand that returning members are subject to increases in initiation fees, membership dues, freeze fees, etc. I authorize Halo Med Spa to charge my credit card that is on record with Hao Med Spa for any outstanding balances that remain on my account upon the successful cancellation of my membership. Failure to pay after 30days will result in termination of the membership with the $199 fee being charged to the card on file. If there is not a card on file you will be invoiced the amount owed.
Type option 1
I understand that this is only a request for cancellation of membership and the cancellation date of my membership will be communicated to me upon the successful review of my membership agreement and account by a membership account representative of Halo Med Spa.
Type option 1
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date
-
Month
-
Day
Year
Date
By signing this form you are agreeing to cancel your Halo Membership. There'll be no further services billed under the canceled membership.
Submit
Should be Empty: