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Name of Wellness Member
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Billing Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
- Click here if location of massage is different than the billing address
Address of Massages
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Email
Date
Referred By:
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Terms & Conditions
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- Not valid with any other offers; massage appointments must be cancelled with 24 hours notice or more to avoid charges; individual membership only; additional massages may be used for others at membership rate.
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- This monthly membership is a 12-month commitment. All accumulated massages will be forfeited when membership ends. To cancel your membership, you must give a 30 day notice, you must complete & execute the official Mass Mobile cancellation form and mail it USPS to Mass Mobile. Service ends 30 days before your cancellation date. If there is a recurring charge during the 30 days of notice it is non-refundable or usable for massages.
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- By checking here I agree to the Membership Type selected, Payment Type selected and the Terms and Conditions. I authorize Mass Mobile Massage to process credit card transactions from my account. I understand that this authority will remain in effect until the proper procedures are followed to cancel my membership.

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