Name First Last BronzeGoldPlatinumEliteRoyal12 Months $6512 Months $8512 Months $12012 Months $14012 Months $32012 Months $7512 Months $9512 Months $14012 Months $16012 Months $42012 months Royal $32012 months Elite $14012 months Platinum $12012 months Gold $8512 months Bronze $656 months Royal $4206 months Elite $1606 months Platinum $1406 months Gold $956 months Bronze $75I,_____________________________ authorize Ideal Body Clinic to deduct membership fee of $_______tx the first of every month for the period of ____________________ from the credit card information provided below, or a series of post dated checks that are provided, or the full amount of $________tx that has been prepaid.full namefee chosenPlease note that treatments not used in the present month are not able to be transferred to the following month. There is no refund or exchange on the amount which has been paid. This member contract is non-transferable. Also, 30% penalty charged on the total amount of the contract in case of cancelation. Before signing this document. I have read, understood and herby agreed to the terms and conditions of membership.Credit Card InformationMasterCardVisaCredit Card NumberExpiration DateMembership Start Day Date Format: MM slash DD slash YYYY Membership End Day Date Format: MM slash DD slash YYYY Today's Date Date Format: MM slash DD slash YYYY Signature Like Us On FacebookAppointmentsWe will do our best to accommodate your busy schedule. Request an appointment today!Request AppointmentContact Us (514) 998-0998 Ideal Body Clinic Montreal Ideal Body Clinic South Shore Ideal Body Clinic Montreal East Call Us Text Us
