Schedule Appointment with Allium Massage

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First Name *

Last Name *

Phone *

Your E-Mail Address *

Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
In-Office 60-Minute	x $135.00	$135.00 per month
Total: $135.00

I authorize Allium Massage LLC to automatically bill my credit card on file for my membership. If I wish to cancel my membership, I will notify Allium Massage in writing by 7 business days before my card is due to be charged. If my card is declined, I agree to pay Allium Massage for any outstanding services within 7 days and to reimburse Allium Massage for any fees incurred due the late or declined payment. The membership autopay is non-refundable, but appointments can be rolled over to the next month or transferred to someone else.