Chair Massage Service Request Form

Chair Massage Service Request Form

Please fill out this form to schedule your chair massage at your business or event.
Sessions are 15 minutes per person
PRICING:

Up to 3 hours = $40 /person

Over 3 hours = $168 / hour
Business Name*

First NameLast Name
Contact Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Preferred Date(s) and Time(s) (please list a start and end time)*
Estimated number of people attending*
Billing To*

First NameLast Name
Billing Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Billing Email*
example@example.com
Billing Phone Number*
Please enter a valid phone number.
Payment Terms and Conditions*
For events under 3 hours, I agree to submit a completed sign-up sheet via email (to michstone1211@gmail.com) within 24 hours to ensure accurate billing.
Should be Empty: