Membership Transfer/Cancellation Information Request Form
In order to continue The Ultimate Wax Experience, we ask that you provide the information bellow.

Date: Monday May 21, 2012
First Name:
Last Name:
Home Phone:   
Mobile Phone:   
Email:
Membership Type:
Location Purchased:
Purpose of this Form:
Reason:

Submitting this form does not constitute a formal cancellation of any kind. It merely submits a request to be contacted by a representative from the
appropriate location to discuss your options with regards to your specific membership type.