Lasik contract

Lasik Deposit Form

VeneermeNow
Name*

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date interested in traveling, if you do not have one; skip.

MonthDayYear
Date
I understand the $515 usd deposit will be deducted from my balance.*

YesNo
I understand the final balance must be paid upon arrival to receive services.*

YesNo
I understand during the Migration process entering the country; Jazzytheconnect is not and cannot be held responsible in case entry to the country is denied for personal or legal reasons.*

YesNo
I understand cancellations must be requested 5 days prior to the appointment date to avoid a penalty fee of $250 usd.*

YesNo
If, for any circumstances, services acquired along the package cannot be rendered, Jazzytheconnect will reimburse the buyer the cost of the service not labor.*

YesNo
I First Name* Last Name* , understand the $500 usd lasik deposit is non-refundable nor transferrable.
Signature* .
Should be Empty:

Lasik Deposit Form