Card On File Authorization

Card On File Authorization Agreement

This authorization allows Recover Cryo to securely maintain a payment method on file for future authorized transactions related to services received. Your payment information will be handled confidentially and used only as described in this Agreement.

Client Information

Full Name *

Date of Birth *

Phone Number *

Email Address *

Billing Address *

City *

State

ZIP / Postcode *

Payment Card Information

Name as it Appears on the Card *

Card Type *

Visa Mastercard American Express Discover Other:

Last Four Digits *

Expiration Date *

/

Billing ZIP / Postcode *

Cardholder Authorization

I authorize Recover Cryo to securely retain my payment information for the purpose of processing authorized charges related to services that I request or receive.

I understand that my payment information will be stored using reasonable administrative and technical safeguards designed to help protect my information from unauthorized access.

I understand that Recover Cryo does not store complete credit card numbers in unsecured written records and will make reasonable efforts to protect my financial information.

Client Initials *

Authorized Charges

I authorize Recover Cryo to charge the payment method listed above for:

Individual Treatment Sessions Treatment Packages Memberships (if applicable) Approved Retail Products Gift Certificates purchased by me Late Cancellation Fees No-Show Fees Outstanding Balances that I have authorized

I understand that Recover Cryo will not process unauthorized charges unrelated to services I have requested or agreed to receive.

Client Initials *

Cancellation & No-Show Policy

Appointments are reserved specifically for each client.

I understand and agree that:

Appointments cancelled with at least 24 hours' notice will not incur a cancellation fee.
Appointments cancelled with less than 24 hours' notice may be subject to a cancellation fee.
Failure to attend a scheduled appointment without notice may result in a no-show fee.
Outstanding balances may be charged to the payment method authorized in this Agreement.
Recover Cryo reserves the right to refuse future appointments for repeated late cancellations or unpaid balances.

Client Initials *

Payment Disputes

I agree to notify Recover Cryo promptly if I believe a charge has been processed incorrectly.

I understand that Recover Cryo will make reasonable efforts to investigate and resolve any billing concern before additional action is taken.

I agree not to initiate a chargeback for services that I knowingly received unless Recover Cryo has first been given a reasonable opportunity to resolve the matter.

Client Initials *

Changes to Payment Information

I understand that it is my responsibility to notify Recover Cryo if:

My payment card expires.
My card is replaced.
My billing information changes.
My card is lost or stolen.
I wish to replace the payment method on file.

Failure to maintain valid payment information may delay future appointments or services.

Client Initials *

Revocation of Authorization

This authorization shall remain in effect until:

I provide written notice requesting its cancellation.
Recover Cryo terminates this Agreement.
The payment method expires and is not updated.
Applicable law requires termination of this authorization.

Revoking this authorization does not eliminate my responsibility for outstanding balances incurred before the authorization was revoked.

Client Initials *

Client Certification

By signing below, I certify that:

I am the authorized cardholder or have legal authority to authorize the use of this payment method. The information provided is true and accurate. I have read and understand this Card on File Authorization Agreement. I have had the opportunity to ask questions before signing. I voluntarily authorize Recover Cryo to maintain my payment information on file in accordance with this Agreement.

Client Signature

Cardholder Name (Print) *

Electronic Signature *

Date *

Submit Card Authorization

By submitting this form electronically, you acknowledge that your electronic signature is legally binding and that the information provided is complete and accurate to the best of your knowledge.