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REDISCOVER WELLNESS

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Last Name *

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

Item	Quantity	Total
Optimal Escape 80min	x $320.00	$320.00 per month
Total: $320.00	Coupon:

I understand that there is a 12 month commitment for Massage memberships. If the 12 month Massage commitment is broken, I understand that there is a $100 cancellation fee.

I understand packages do not expire and can be shared with others. We do not offer refunds on un used packages.

I certify that I am an authorized user of this credit card and will not dispute the scheduled transactions with my bank or credit card company; provided the transactions correspond to the terms indicated in this authorization form.

I have read these terms and by submitting the request I agree with it.

The Massage Clinic Gift Certificate contains value, which may be used to purchase services at face value. This certificate cannot be used to purchase other gift certificates. The Gift Certificate must be presented at the time of purchase and the available balance will be applied to the transaction. Prices are subject to change without notice. This certificate is non-refundable and may not be redeemed for cash. This certificate is not transferable and The Massage Clinic is not responsible for any lost, stolen, damaged or unauthorized use of the certificate. No expressed or implied warranties apply.