Membership Form - Golden Express

1

Full Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Please enter a valid phone number.

3

May we have the Email Address you used to sign up?* This field is required.

example@example.com

4

Are you here to freeze or cancel your membership?* This field is required.

Freeze

Cancel

5

How long do you want to freeze for?* This field is required.

30 days

60 days

90 days

6

I understand that at the end of 30 days, my membership will resume and I will be charged again for facial credits. During the freeze, I may use any of my benefits for facials. I understand that I will not be refunded or receive store credit for unused credits if I later decide to cancel.* This field is required.

I Agree

7

I understand that at the end of 60 days, my membership will resume and I will be charged again for facial credits. During the freeze, I may use any of my benefits for facials. I understand that I will not be refunded or receive store credit for unused credits if I later decide to cancel.* This field is required.

I Agree

8

I understand that at the end of 90 days, my membership will resume and I will be charged again for facial credits. During the freeze, I may use any of my benefits for facials. I understand that I will not be refunded or receive store credit for unused credits if I later decide to cancel.* This field is required.

I Agree

9

May you tell us why you are canceling your membership?* This field is required.

Wasn't using my facials

Had a billing issue

Moving out of town

Costs too much

Other

10

I understand that if I don't complete this cancellation 3 days prior to my next billing, Golden Hour With Haneen can not guarantee my membership will be cancelled on time.* This field is required.

I Agree

11

I understand that after I submit this form, I have 30 days to use any remaining treatments. After that, remaining treatments will be lost.* This field is required.

I Agree

12

I understand that I will not be refunded or receive store credit for unused treatments.* This field is required.

I Agree

13

I understand that if I renew my membership at a later date, any unused benefits will be restored.* This field is required.

I Agree

14

Please sign below.* This field is required.

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15

Today's Date* This field is required.

Date