Island Club Membership Freeze Form
Date
*
/
Month
/
Day
Year
Member Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
What is your preferred method of contact?
*
Phone
Email
No preference
How long have you used our facilities and equipment?
*
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years or longer
How would you rate our services
*
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Customer Service
Knowledge of Equipment and Products
Quality of Equipment
Understanding Customer Needs
Sales Staff
Pricing
Cleanliness
Responsiveness
Friendliness
I understand I will be billed $4.95 per month for every month my account is frozen. I understand that all monies drafted will be placed on my account for my use when I re-activate my membership.
*
Yes, I understand
No, I do not understand
I understand, per my agreement with Envy Island Tan, Inc. when I joined the Membership Club, I will be billed for 1 additional month if the date and time stamp on this request is not completed and received by midnight on the 20th of the month. I also understand that my account must have drafted 1 time before any change will take affect to my account.
*
Yes, I understand
No, I do not understand
We understand that you wish to freeze your membership?
*
Yes, freeze my membership
No, Please contact me
Member Signature
*
Submit
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