Welcome to our membership program!

Commit to caring for yourself by contributing to
a personal treatment savings plan.
Redeem “banked” funds whenever you’d like.

For $100/Month, Members enjoy:

$11 Unit Botox
5% Dermal Fillers
5% Spa Services

Discounts cannot be applied to packages. Membership is a 6 month minimum and payments are withdrawn automatically.

Please check the box next to the following terms and conditions in the space to the left of each numbered line.

Payment*
1. You will pay the monthly membership amount of $100.00* by credit/debit card on the same day each month. Your first payment is due today.
Membership Details & Notice*
2. You are joining our aesthetic membership for $100 per month. Your membership is paid monthly which allows you to “bank” funds for future treatments. Belonging to our membership allows you to enjoy such discounts on treatments such as: Botox, Fillers, and Spa Services. * Please see our current service menu for special discounts for member ONLY!
3. Your membership begins today and reoccurs for 6 Months with no cancellation and will be automatically renewed at the end of 6 Months at the same rate unless you give two weeks written notice. Central Utah Aesthetics will provide a notice form to fill out.
*
4. If you relocate out of state during the 6 Months of membership, you will give a one-month notice to cancel and proof of out of state residence. Central Utah Aesthetics will provide a notice form to fill out.
Fees:*
5. You will be responsible for any fees Central Utah Aesthetics incurs as a result of insufficient funds or a failure to inform us that your credit card has changed or expired.
Acceptance:*
6. You acknowledge receiving and reading a completed copy of this agreement before signing. By signing below, you agree to the terms and conditions as stated in this document.
Your Name*
First Last
Email
Date*
MM slash DD slash YYYY
Monthly Membership*
Price:
Price includes a 3.5% online convenience fee.
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Please advise us of any changes regarding the credit card on file or the need to change the chosen date of your monthly payment.
Central Utah Aesthetics agrees to notify all members of any necessary changes to the membership program.

Your Information

Welcome to our membership program!

Commit to caring for yourself by contributing to a personal treatment savings plan. Redeem “banked” funds whenever you’d like.

Commit to caring for yourself by contributing to
a personal treatment savings plan.
Redeem “banked” funds whenever you’d like.