New Form Name*Location*LocationSouth TulsaDowntown TulsaBroken ArrowOklahoma CityCharge Amount*Recurring Bill Day Date Format: DD slash MM slash YYYY FrequencyWeekMonthYearQuarterBilling InformationBilling Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone #Email* Recurring Credit Card Payment Authorization By signing this agreement, you have authorized Aromascapes, LLC to regularly scheduled charges to your credit card for your monthly dues (credit card charge). You will be charged the amount indicated each billing period. A receipt for each payment will be provided to the email designated in form and the charge will appear on your credit card statement. You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notices from Aromascapes, LLC at least 15 days prior to the payment being collected. Likewise, you have the right to cancel service and recurring charge with notice at least 15 days prior to payment being collected. You can cancel services at anytime by calling Aromascapes, LLC directly. Payment Authorization As a convenience to me, I authorize regularly scheduled credit card charges to make payments to Aromascapes, LLC. I agree that treatment of such payment shall be the same as if it were signed personally by me. Payment shall be made via the following method: ANY HOLDER OF THIS MEMBERSHIP AGREEMENT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICE OBTAINED WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY DEBTOR HEREUNDER. I understand that this authorization will remain in effect until I cancel in writing and I agree to notify Aromascapes, LLC in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of the U.S. law. I certify that I am an authorized user of this credit card and will not dispute these scheduled transactions, so long as the transactions correspond to the terms indicated in this authorization form..I have read and fully understand the cancellation policy and billing procedure.* Yes No SignatureDate* MM DD YYYY Send me a copy Send me a copy of the agreement Email