Fill out the information below!
This will allow us to set up your membership correctly!
Last Name
First Name
Billing Address:
City
Zip Code
State
Phone #
E-mail
Please fill out your Billing information!
We will not bill anything to your card until we speak with you via phone.
Type of Credit Card
Name on Credit Card
Exp
Security Code:
Credit Card #
I,
agree that I have provided valid photo identification, and authorize Australian Tan
to charge the above listed credit card or checking account in the amount of $
each month until I cancel
according to the terms of this membership outlines below. I understand that my membership must reflect
successful
draw(s) from the date this agreement commenced before I may request to freeze or cancel my membership.
By signing below, I am stating that I have full access to the above billing account and will be solely responsible for the
automatic charges made by Australian Tan to that account. I am also confirming that I have read and fully understand the
Membership Terms and Policies listed below and that are stated in Australian Tan’s posted signage. As a parent signing
this agreement, I have also read and fully understand the Membership Terms and Policies listed below, and consent to the
use of the tanning equipment by my minor.
Please Read the Term and Conditions Carefully!
Check the boxes on the right to signify your agreement & understanding!
This is an open ended agreement and payments will continue until you complete and sign an Australian Tan
cancellation form and mail to corporate offices.
Today's payment covers tanning for the remainder of this month plus any applicable sign up fee. Your first complete
month’s payment is automatically billed on the 1st of the month
You may cancel or freeze any time after your automatic payment term is complete
Cancellations, freezes and payment type changes can ONLY be made by mailing in a signed form to Australian Tan’
s corporate offices to be received any time on or before the 28th day of the month. Changes to your account are not
accepted verbally, by email or phone, and no claims of such will be recognized.
There is no refunds for unused months. You may freeze your account in order to avoid full payment after your
automatic payment term is complete
Automatic payments are processed on the 1st of the month.
Prepayments are welcome and must be made at Australian Tan anytime on or before the last day of the month
This plan cannot be shared or transferred
Australian Tan may re-process dishonored automatic payments
Australian Tan consents only to agreements in writing and not verbal agreements
Australian Tan may modify or cancel this plan at any time. Changes may be made by posting in the lobby of the
Australian Tan locations
Choosing the Membership Plan
Please fill out appropriate areas with Membership Consultants help!
Membership chosen
# of Terms
Type your name
Monthly Amount
