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LUX 30 DAY'S ONLINE EFT DEACTIVATE FORM

Customer Initial:


I hereby request the described changes to be made to my account. I understand that all original terms and conditions I agreed to will continue to apply to account.

Date: March 14, 2025

First Customer's Name

First Name*

Last Name*

Phone*
First Customer's Age Acknowledgment*
First Customer's Date of Birth*
I certify that I am 18 years of age or older
First Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
First Customer's Signature*
Second Customer's Name

First Name*

Last Name*
Second Customer's Date of Birth*
Second Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
Third Customer's Name

First Name*

Last Name*
Third Customer's Date of Birth*
Third Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
Fourth Customer's Name

First Name*

Last Name*
Fourth Customer's Date of Birth*
Fourth Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
Fifth Customer's Name

First Name*

Last Name*
Fifth Customer's Date of Birth*
Fifth Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
Sixth Customer's Name

First Name*

Last Name*
Sixth Customer's Date of Birth*
Sixth Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
Seventh Customer's Name

First Name*

Last Name*
Seventh Customer's Date of Birth*
Seventh Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
Eighth Customer's Name

First Name*

Last Name*
Eighth Customer's Date of Birth*
Eighth Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
Ninth Customer's Name

First Name*

Last Name*
Ninth Customer's Date of Birth*
Ninth Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
Tenth Customer's Name

First Name*

Last Name*
Tenth Customer's Date of Birth*
Tenth Customer's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
Parent or Guardian's Email Address

Email*
Check to receive information, news, and discounts by e-mail.
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Change Plans:*
Reason For Cancel?*
How would you rate your experience with us?*

Any comments or suggestions for improving our salon/ services?
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.


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