Radiance Membership Application

Radiance Membership Sign-Up Form
Welcome to the Radiance Membership

This application is for clients who are ready to commit to glowing skin with a customized monthly facial. Please complete the form below to begin the enrollment process. A recurring Zelle payment or credit card is required to process your monthly membership fee. If you're new to Radiante, you must first complete your "New Client Consult and Facial" before enrolling in the membership.
Client & Contact Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number where we can reach you.
Email*
example@example.com
Birthday

MonthDayYear
Optional, but great for gifts!

Billing Agreement
Membership Fee Authorization

The Radiance Membership is $185 per month for the Premium Tier and $150* per month for the Classic Tier and will be automatically charged on the [chosen day] of each month. Membership is a 3-month minimum commitment. After that, it converts to month-to-month with a 30-day cancellation notice required via text message or email at radiantebymaria@gmail.com.

To preserve the integrity of our membership program and keep scheduling consistent, tier changes are limited to once per quarter (every 3 months). Please notify us in writing to make changes.

*New price as of June 26, 2025

By submitting this form, you agree to be charged monthly for your membership and understand the terms outlined.
Monthly Plan Selection

Premium Tier: $185 / month for advanced custom treatmentsClassic Tier: $150 / month for the Essential Custom Facial
Choose your preferred billing date*

1st of the month15th of the month
Approximate start month / year:
I understand and agree to the membership terms and automatic billing.
Membership Status (internal use only)
Answer from client is not required

Payment Options

To activate your Radiance Membership, please choose one of the following payment methods. Your monthly membership fee will be collected on your selected billing date.
Option 1: Pay by Card (via GlossGenius)
We will manually charge your card each month using our secure processor, GlossGenius.
Please note:
- A 3.5% processing fee applies to all card transactions.
- At this time, it's unclear whether this fee will remain once GlossGenius introduces automated membership billing. We will keep you informed of any updates.
Option 2: Pay via Zelle (No Processing Fee)
You may choose to send your payment via Zelle to avoid the processing fee.
Please send your payment to (305) 206-1630. Thank you.
- Payments must be sent on your selected billing date.
- Many banks offer the option to set up recurring Zelle payments—please check your banking app for instructions.
- If payment is not received by your selected billing date, a Zelle request will be sent to you before the close of business that day.
Please select your preferred payment method for monthly membership billing:*

Credit/Debit Card (includes 3.5% processing fee); Due to JotForm's policies, we are unable to collect the full card information on this form. Therefore, we suggest reaching out to us to provide us with the full card number which we will then save under your profile for future payments.Zelle (no processing fee – must be sent on billing date); Proceed to sign this form and submit to Radiante.
Your selection helps us set up your membership accurately. If you'd like to change your method later, just let us know in advance.
Cardholder Name

First NameLast Name
Card Type
Card Number
Card Expiration
Security Code
Billing Zip Code
Authorization & Agreement

By signing below, I authorize Maria Garcia and RBM Esthetics LLC to charge the card on file or receive/request payment via Zelle for recurring membership fees and applicable retail purchases.

I understand that:

Payments are due monthly, based on the membership plan I’ve selected.
Cancellation requires written notice at least 30 days in advance.
If billing details need to be updated, I agree to notify Radiante at least 5 days before my billing date.
If using Zelle, payment must be manually submitted by the due date.
A grace period of 3 days is allowed for late payments.
If payment is not received within this time:
A $15 late fee may be applied.
Signature*

Clear
Should be Empty:

Radiance Membership Sign-Up Form

Welcome to the Radiance Membership

Client & Contact Information

Billing Agreement

Payment Options