New Client Consultation Form

Date*

MonthDayYear

Name*

First NameLast Name

Date of Birth*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

I authorize Nooshin Skin Care to charge the provided credit card for the amount agreed upon above on the first of each month. Please N/A*

Agreement:Nooshin Skin Care Membership gives you premier access to experience every month.As a Nooshin Skin Care Member you will receive the following benefits:• for monthly fee of $60, once per month you will have your choice of any service with 20% off.. Check out will be your service price with 20% off, minus $60.Example: ( $100 service - 20% = $80, minus your $60 monthly =$20 ).• If for some reason you cannot make it into the spa on any given month, any unused monthly treatment will not “roll over” to the following month, but you will be able to offer your time to someone else,( friends, family ).• During your birthday month Member will receive a free upgrade of your choice to add on any treatment.Members receive 10% off for any product. Please N/A*

I, agree to the terms and conditions outlined below and authorize Nooshin Skin Care to charge my credit card on the first day of each month, until I canceled my membership Please N/A*

Signature*

Client Membership Form