HALO Membership Auto Draft Consent
Street Address Line 2
State / Province
Postal / Zip Code
Monthly Membership Types (1 time $49 Setup fee)
VIP Membership - Monthly Price $199
Laser Hair Removal Membership Extra Large - $260
Laser Hair Removal Membership Large - $169
Laser Hair Removal Membership Medium - $109
Laser Hair Removal Membership Small - $99
Laser Hair Removal Membership Extra Small - $89
Desired Payment Option
Annually (Pay All At Once Now)
Bill My Card on File
BOA, Sandia CU, ect.
Bank Account Name
Savings or Checking
Bank Account Number
Banking Institution Phone Number
I agree to allow Halo Med Spa to auto draft the listed membership amount on the 1st of each month for (1) year unless I have selected to pay annually. Auto renewal will be active unless the client makes arrangements with Halo Med Spa management before the 12th billing cycle. I understand that failure to have sufficient funds may result in immediate cancelation of my membership and a refund will not be issued. After 30 days past due cancelation of the membership will be processed. An early termination fee of $199 will be assessed if you have not met the required 1 year commitment at the time of cancelation and automatically billed to your card on file.
I agree to the above.
Should be Empty: