Loading...

Request to Cancel or Freeze Membership (Please note that you must submit 1 per membership if you have multiple membership agreements with us that you wish to cancel and/or freeze)

 

Please read and initial the following:

I understand that if I am within my initial 3 month commitment period, my membership will not be canceled or frozen until the 3 month commitment has been met per my membership agreement.

I understand that I will not be able to rejoin a membership program with Elixr Wax Bar for at least 60 days after cancellation. (ex. If I cancel in May, I may not be able to join again until August)

I understand that if this notice is submitted within 5 business days from the 1st of the month, it will not be processed until the following month.

I understand that if freezing my membership, I may freeze my membership for up to 2 months at a time and no more than once per year. 

I understand that upon cancellation of my membership, I will have till the end of the last billed month to use any remaining benefits & services before they expire with my membership.

I understand that if I am freezing my membership my benefits will also remain frozen in my account and can be used once my membership is active again and no longer frozen.

Per my membership agreement form, I understand that any unused services that will expire at the end of my membership can not be transferred towards other services, account credits or refunded.

Date Signed: November 22, 2019

 

First Guest's Name

First Name*

Last Name*

Phone*
First Guest's Date of Birth*
I certify that I am 18 years of age or older
First Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

First Guest's Signature*
Second Guest's Name

First Name*

Last Name*
Second Guest's Date of Birth*
Second Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

Third Guest's Name

First Name*

Last Name*
Third Guest's Date of Birth*
Third Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

Fourth Guest's Name

First Name*

Last Name*
Fourth Guest's Date of Birth*
Fourth Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

Fifth Guest's Name

First Name*

Last Name*
Fifth Guest's Date of Birth*
Fifth Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

Sixth Guest's Name

First Name*

Last Name*
Sixth Guest's Date of Birth*
Sixth Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

Seventh Guest's Name

First Name*

Last Name*
Seventh Guest's Date of Birth*
Seventh Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

Eighth Guest's Name

First Name*

Last Name*
Eighth Guest's Date of Birth*
Eighth Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

Ninth Guest's Name

First Name*

Last Name*
Ninth Guest's Date of Birth*
Ninth Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

Tenth Guest's Name

First Name*

Last Name*
Tenth Guest's Date of Birth*
Tenth Guest's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

Parent or Guardian's Email Address

Email*
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
I would like to*

 my membership.


My last month as a member to be charged is/was: *

Reason for freeze or cancellation: *

If freezing, please select below the month or months to freeze that you wish not to be charged during:

Please make sure not to select the current month if you have already paid for your membership on the 1st.

May only choose 1 or 2 months.
January
February
March
April
May
June
July
August
September
October
November
December

A one time $5 Service fee applies per membership for freezing.

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