Deep Roots Massage Membership Application

Deep Roots Massage Membership Application

Agreement & Security Deposit
Welcome! Congratulations on making a commtiment to your own health and wellness.

The membership application is the first step in a two part process. Once you have completed this one year agreement and paid the security deposit you're halfway there!

Next, you'll need to call us with your preferred card number for monthly billing in order to activate your membership.

Please call 603-352-0734 if you have any questions.

See you soon!
Date

MonthDayYear
Date

Please choose your membership.*

60 Minute Monthly Massage Membership Security Deposit

$76.00

75 Minute Monthly Massage Membership Security Deposit

$95.00

90 Minute Monthly Massage Membership Security Deposit

$114.00

Total

$0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Email*
example@example.com - Please use the best email to reach you on the day of your massage.
Phone*

Area CodePhone Number - Please choose the best number to reach you on the day of your massage.
I would like my membership to begin:*

Today. Choose this option ONLY if you plan to have a massage within this calendar month.On the first day of next month.
Pending completion of the member agreement, automated monthly billing of {pleaseChoose} will begin on my next appointment, occuring within the same calandar month as today's date {date} and will continue on the first day of each month following for a minimum of 11 months.

After 11 months of membership, membership auto renews on a month-to-month basis. Written notice of at least 30 days is required to discontinue membership.

Member rates are 20% below standard rates. Should standard rates for massage increase member rates increase will increase accordingly.
Pending completion of the member agreement, automated monthly billing of {pleaseChoose} will begin on the first day of the first month following today's date {date} and will continue on the first day of each month following for a minimum of 12 months.

After 12 months of membership, membership auto renews on a month-to-month basis. Written notice of at least 30 days is required to discontinue membership.

Member rates are 20% below standard rates. Should standard rates for massage increase member rates increase will increase accordingly.
I understand and agree to the following:*

MEMBER RATES: For the duration of my membership, gift certificates, additional massage appointments and additional massage time are available to me at specially discounted member rates. Member rates are 20% below standard rates. Should standard rates for massage increase member rates increase will increase accordingly.MASSAGE CREDITS: Each monthly massage credit is valid for two months only. After two months, if my massage credit is not used, it will automatically expire. Expired credits cannot be recovered. Monthly massage credits (current or expired) cannot be converted to gift certificates.SECURITY DEPOSIT: My membership plan requires an initial security deposit, equal to one monthly charge, which is held on my account at Deep Roots for the duration of my membership.ONE YEAR MINIMUM COMMITMENT: My membership starts on date as indicated above and must be maintained for a period of 12 months.EARLY TERMINATION: If I choose to discontinue my membership before my 1-year (12 month) commitment is complete, or after my 12 month commitment without 30-day advance notice, I understand that I will forfeit my security deposit.AUTO RENEW: My membership will auto renew after one year. If I choose to discontinue at any time after that, I will give a minimum of 30-days’ advance notice in writing by emailing info@deeprootsmb.com. I may then use my security deposit to pay for my last month of membership.BILLING INFORMATION: I am responsible for maintaining up-to-date billing information at all times, and I will be notified if my credit card fails to authorize for any reason. If my account becomes more than 30 calendar days past due, my membership will be deactivated and I will forfeit my security deposit.LATE CANCELLATIONS: My account will be charged for any appointments scheduled under my membership that are cancelled with less than 24 hours’ notice. If I cannot make my appointment, it is my responsibility to give 24 hours’ advanced notice, or arrange for someone else to take my place.NO-SHOWS: My account will be charged for any missed appointments under my membership.SHARED MEMBERSHIP: Should I choose to share my membership privileges with a member of my family, I understand that I am responsible for all charges, including no-shows and late cancellations. Call 603-352-0734 to add people to your account.BEING KIND (The Sanity Clause): I will act in a manner that is courteous and respectful in all interactions with Deep Roots staff.
Signature*

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