Image Sun Tanning Centers! VIP Package Registration Form □New VIP □Modify VIP □Upgrade VIP □Downgrade VIP

Customer Name (Person who package is for) ________________________________________________________________________________ Billing Information (Person responsible for payment)

First Name:__________________________________ Last Name:________________________________________________ Address:________________________________________________________________ Apt.#__________________ City:______________________________________________________ State:______________ Zip:___________________ Home Phone#( )___________________________ Other Phone#( )____________________________

Monthly Payment Amount $_________ Package Name: __________ Amt. Pd. $______ First Bill Date _________________ Account Information Your full name as it appears on your account or credit/debit card__________________________________________________________________ Circle one: VISA MC AMEX DISC Check Acc. Saving Acc. Credit/Debit Card Account # _______________________________________________ Exp. Date:___________ or Checking/Savings Account # ________________________________________________ Rte.#______________________________________________ Bank Name _______________________________________________________________ City______________________________________________

Employee has informed me of the cancellation procedures including the 31 day notice. I understand that my bank account or credit card will be billed once a month on, or approximately on, the 25th of each month.. Customer initials __________ Employee initials _______

Note: Customer can cancel package anytime after purchase date with a minimum of 31 days notice before next payment is due. If proper 31 day

notice is not provided, the next payment will be billed in the Full Payment amount as agreed above and will become the Final Payment. If the package is cancelled within 30 days from the signup date, a $15.00 early cancellation fee will be charged. If customer is downgrading their membership they will be billed one final original membership fee, before new membership price will be charged. Customer agrees to forfeit all “FREE SESSION POINTS” received and reduce the amount of “VIP SESSION POINTS” purchased to half at time of cancellation. A $15 fee will be charged on all payments returned “unpaid” or “declined”.

VIP Package Agreement Customer reserves the right to cancel VIP Package at any time by completing a “VIP INFORMATION FORM” 31 days prior to cancellation at the Image Sun Tanning Center place of purchase. VIP Tanning privileges are subject to current in-store terms and conditions. Image Sun reserves the right to change VIP Package billing date, terms, conditions, fees, and privileges at any time without notice. Customer promises to use only tanning lotions, gels, or oils that are manufactured specifically for indoor tanning use. No baby oils, outdoor lotions, etc. are allowed. If member fails to abide, he/she may be liable for any damage to acrylic shields on tanning beds. Image Sun and its Management reserves the right to terminate any package at any time with or without reason. All judgments and decisions are at the full discretion of Image Sun and it’s Management.

Authorization I hereby authorize Image Sun Tanning Centers to draft my account directly or through a private billing company as described above. I have read this agreement and have received a copy. I understand that I can cancel my VIP Package at any time by visiting the Image Sun Tanning Center place of purchase & completing and signing a “VIP INFORMATION FORM” 31 days prior to cancellation. Member Signature X_______________________________________________________________________ Date__________________ Employee Signature X_______________________________________________________________________ Date__________________ Image Sun Copy White Members Copy Yellow

Image Sun Tanning Centers! VIP Package Registration Form □New □Modify □Upgrade VIP □Downgrade VIP

Customer Name (Person who package is for) ________________________________________________________________________________ Billing Information (Person responsible for payment)

First Name:__________________________________ Last Name:________________________________________________ Address:________________________________________________________________ Apt.#__________________ City:______________________________________________________ State:______________ Zip:___________________ Home Phone#( )___________________________ Other Phone#( )____________________________

Monthly Payment Amount $_________ Package Name: __________ Amt. Pd. $______ First Bill Date __________________ Account Information Your full name as it appears on your account or credit/debit card_________________________________________________________________ _ Circle one: VISA MC AMEX DISC Check Acc. Saving Acc. Credit/Debit Card Account # _______________________________________________ Exp. Date:___________ or Checking/Savings Account # ________________________________________________ Rte.#______________________________________________ Bank Name _______________________________________________________________ City______________________________________________

Employee has informed me of the cancellation procedures including the 31 day notice. I understand that my bank account or credit card will be billed once a month on, or approximately on, the 25th of each month.. Customer initials __________ Employee initials _______

Note: Customer can cancel package anytime after purchase date with a minimum of 31 days notice before next payment is due. If proper 31 day

notice is not provided, the next payment will be billed in the Full Payment amount as agreed above and will become the Final Payment. If the package is cancelled within 30 days from the signup date, a $15.00 early cancellation fee will be charged. If customer is downgrading their membership they will be billed one final original membership fee, before new membership price will be charged. Customer agrees to forfeit all “FREE SESSION POINTS” received and reduce the amount of “VIP SESSION POINTS” purchased to half at time of cancellation. A $15 fee will be charged on all payments returned “unpaid” or “declined”.

VIP Package Agreement Customer reserves the right to cancel VIP Package at any time by completing a “VIP INFORMATION FORM” 31 days prior to cancellation at the Image Sun Tanning Center place of purchase. VIP Tanning privileges are subject to current in-store terms and conditions. Image Sun reserves the right to change VIP Package billing date, terms, conditions, fees, and privileges at any time without notice. Customer promises to use only tanning lotions, gels, or oils that are manufactured specifically for indoor tanning use. No baby oils, outdoor lotions, etc. are allowed. If member fails to abide, he/she may be liable for any damage to acrylic shields on tanning beds. Image Sun and its Management reserves the right to terminate any package at any time with or without reason. All judgments and decisions are at the full discretion of Image Sun and it’s Management.

Authorization I hereby authorize Image Sun Tanning Centers to draft my account directly or through a private billing company as described above. I have read this agreement and have received a copy. I understand that I can cancel my VIP Package at any time by visiting the Image Sun Tanning Center place of purchase & completing and signing a “VIP INFORMATION FORM” 31 days prior to cancellation. Member Signature X_______________________________________________________________________ Date__________________ Employee Signature X_______________________________________________________________________ Date__________________ Image Sun Copy White Members Copy Yellow