Treatment and Financial Agreement Treatment and Financial Agreement Treatment and Financial Agreement Client Name * Date Notes * Expires Treatment Area Price Total Discount Price Total Product Price Total Hair Removal IPL Skin Pen Microdermabrasion Chemical Peel CoolSculpting Vaser/Vela Shape Ultherapy eMatrix Treatment Price Total Product Price Total Sales Prices By signing this agreement I fully understand that all fees paid to Amerejuve are non-refundable. Amerejuve requires full payments prior to scheduling any treatment appointments. All SALES ARE FINAL at the point of purchase. You may exchange any purchase within 6 months of the original purchase date. Purchase exchanges may be applied towards the value of any other requested service. No exchanges will be allowed more than 6 months after original purchase date, except for pregnancy or medical illnesses. The exchange value will be calculated by subtracting the pro-rated value of all services rendered from the purchased amount. ALL PACKAGES EXPIRE WITHIN 1 YEAR OF PURCHASE. Client Signature * Clear Date * Staff Signature * Clear Date * CAPTCHA If you are human, leave this field blank. Submit
