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DIRECT PAYMENT SERVICE ENROLLMENT AGREEMENT

Please fill in this agreement for Sun Seekers Tanning Ltd. and provide a copy of your personal Cheque/Visa/Mastercard unsigned and marked VOID (for verification purposes)

AUTHORIZE - Sun Seekers Tanning Salon

#310-20398 Dewdney Trunk Rd.

Maple Ridge BC.

V2X 3E3

*For joint accounts, all depositors must sign if more than one signature is required on cheques issued against the account. Sun Seekers Tanning reserves the right to process on any day after the 1st but only once a month.

TERMS AND CONDITIONS

Cancellation Terms:

1) I/We will notify Sun Seekers Tanning Ltd. of termination on or before the 21st of the month prior to the next payment due date.

Type Initials

Draw Initials

Initial

2) I/We will notify Sun Seekers Tanning Ltd. of changes to my account prior to the 21st of the month prior to the next payment due date.

Type Initials

Draw Initials

Initial

3) I/We will notify Sun Seekers Tanning Ltd. in writing of any changes in the account information or termination.

Type Initials

Draw Initials

Initial

I/We understand that termination of this authorization does not affect my/our obligation to pay for goods or services contracted for/with Sun Seekers Tanning Salon.

My/Our financial institution will treat each debit as if I/we had personally issued a written direction authorizing Sun Seekers Tanning Ltd. to debit the amount(s) specified to my/our account and need not verify that payments are drawn in accordance with this authorization.

For ANY Returned payments from my institution or credit card there will be a $25.00 processing fee. (Including expired & compromised credit cards)

Type Initials

Draw Initials

Initial

I/We understand that any debits charged to my/our account will be reimbursed once confirmation has been received if;

(a) the debit was not drawn in accordance with this authorization;

(b) this authorization has been terminated; or

(c) the debit was posted to the wrong account due to invalid/incorrect account information supplied by Sun Seekers Tanning Ltd. By giving notice in writing to my/our branch of account within ninety (90) days of the debit to my/our account.

I/We acknowledge that delivery of this authorization to Sun Seekers Tanning Ltd. constitutes delivery to my financial institution.

I/We warrant that all persons whose signatures are required to sign up on this account have signed this authorization.

I/We have read and understood the terms of this authorization.

Today's Date: May 11, 2024

Please select who will be participating...

Adult Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

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First Clients Name

First Name*

Last Name*

Phone*

First Clients Age Acknowledgment*

First Clients Date of Birth*

I certify that I am 18 years of age or older

First Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

First Clients Signature*

Type Signature

Draw Signature

Click to Sign

Second Clients Name

First Name*

Last Name*

Second Clients Date of Birth*

Second Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Third Clients Name

First Name*

Last Name*

Third Clients Date of Birth*

Third Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Fourth Clients Name

First Name*

Last Name*

Fourth Clients Date of Birth*

Fourth Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Fifth Clients Name

First Name*

Last Name*

Fifth Clients Date of Birth*

Fifth Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Sixth Clients Name

First Name*

Last Name*

Sixth Clients Date of Birth*

Sixth Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Seventh Clients Name

First Name*

Last Name*

Seventh Clients Date of Birth*

Seventh Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Eighth Clients Name

First Name*

Last Name*

Eighth Clients Date of Birth*

Eighth Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Ninth Clients Name

First Name*

Last Name*

Ninth Clients Date of Birth*

Ninth Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Tenth Clients Name

First Name*

Last Name*

Tenth Clients Date of Birth*

Tenth Clients Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Clients Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Parent or Guardian's Email Address

Email*

Confirm Email*

Check to receive information, news, and discounts by e-mail.

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 Payment Information

Select form of monthly payment:

Visa

Mastercard

Amex

Chequing

Savings

Payment details to follow

Credit Card or Bank Acct #

Expiry Date or Transit #

Institution# (Bank account only)

For the purpose of:*

Payable Monthly beginning the 1st of: (First Auto Payment - Month) * select next month, unless after the 21st then you will select the month after*

Parent or Guardian's Signature*

Type Signature

Draw Signature

Click to Sign

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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