Loading...

The Desert Dweller 

Membership Agreement

Comany Info: 

The Bronzed Bungalow 

thebronzedbungalow@gmail.com 

(602) 456.9553

4256 N Brown Ave Suite H, Scottsdale, AZ 85251

 

Credit Card Authorization: 

Authorization Type: Recurring Charge (Monthly)

This recurring charge is to cover the cost of unlimited spray tans at The Bronzed Bungalow per month. 

I authorize this business to charge and keep my credit card on file $150.00 on May 11, 2025 and for the same amount on a monthly basis thereafter. 

I acknowledge that I will receive a receipt for each charge made and that no prior notification is needed unless the date or amount of charge is subject to change, in which case The Bronzed Bungalow must notify me of such changes at least 3 days in advance of when the change(s) will take affect. 

I understand that the terms of this authorization will remain in effect until I request that they be terminated. I acknowledge that I am responsible for making this request at least 3 days in advance of the next scheduled charge date to ensure I am not charged again


May 11, 2025

Membership Details:

Once you have read, understood, and agreed to the below; please initial. 

  • This is a recurring membership, your card on file will be charged on the same day every month. 
  • Memberships have a three month commitment, after this commitment has been fulfilled you may cancel your membership prior to your next billing date.
  • Unlimited spray tans a month at The Bronzed Bungalow. 
  • Tans are non transferable.
  • No payment late fees. Please note: you will not be able to tan until your account balance is paid for. 
  • No initiation fees. 
  • If you would like to place your membership on a freeze, please give us 3 days notice via email (thebronzedbungalow@gmail.com) before your next billing date. 
  • Although we hope you never do; if you would like to cancel your membership, please give us 3 days notice via email (thebronzedbungalow@gmail.com)  before your next billing date. 


May 11, 2025

First Member's Name

First Name*

Last Name*

Phone*
First Member's Date of Birth*
First Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
First Member's Signature*
Second Member's Name

First Name*

Last Name*

Phone*
Second Member's Date of Birth*
Second Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Third Member's Name

First Name*

Last Name*

Phone*
Third Member's Date of Birth*
Third Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Fourth Member's Name

First Name*

Last Name*

Phone*
Fourth Member's Date of Birth*
Fourth Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Fifth Member's Name

First Name*

Last Name*

Phone*
Fifth Member's Date of Birth*
Fifth Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Sixth Member's Name

First Name*

Last Name*

Phone*
Sixth Member's Date of Birth*
Sixth Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Seventh Member's Name

First Name*

Last Name*

Phone*
Seventh Member's Date of Birth*
Seventh Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Eighth Member's Name

First Name*

Last Name*

Phone*
Eighth Member's Date of Birth*
Eighth Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Ninth Member's Name

First Name*

Last Name*

Phone*
Ninth Member's Date of Birth*
Ninth Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Tenth Member's Name

First Name*

Last Name*

Phone*
Tenth Member's Date of Birth*
Tenth Member's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Parent or Guardian's Email Address

Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Credit Card Information

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Billing Zip Code: *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!