​Bath Scent of the Month Club
-just choose salt or bomb or both and try a new blend each month
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Membership Agreement for Monthly Bath Bombs with SmileJellybean
Please select your Bath Bomb membership plan. Please print clearly.
r  6 Month Package of $10  per month for 1 Bath Bomb each month for a total of 6 Bath Bombs           
r  12 Month Package of $10 per month for 1 Bath Bomb each month
with an extra one for your birthday month for a total of  13 Bath Bombs   
Or
r  6 Month Package of $18 per month for 2 Bath Bombs each month for a total of 12 Bath Bombs        
r  12 Month Package of $18 per month for 2 Bath Bombs each month with
an extra one for your birthday month for a total of  25 Bath Bombs
This Bath Bomb Membership agreement is being entered into as of ___________ (date).
This agreement is for the purpose of _____________________________ (name), to purchase and receive no less than (_____) bath bomb(s) each month for the next _______ months.
Primary Phone Number: _____________________________________ Circle one: Cell / Home / Work 
Email: ___________________________________________________________________________________________
Mailing Address: _____________________________________ City ______________________ State ______ Zip Code __________

1.  Check box if same as mailing address:                                                                                                                                         

  Billing Address: _____________________________________ City ______________________ State ______ Zip Code __________
Credit Card Type:       r Visa          r MasterCard          r American Express        r Discover                
Credit Card Number ________________________________________      Expiration Date: ________________
CVV code (Three digit code on the back of card):________   Payment:      r  Paid in Full $________________
  r  $_______ Per Month will be ran on the 1st or 15th Day of each month until _________________________
 I hereby authorize SmileJellybean to charge my credit card account in the amount selected  above on the day of the month specified above. This authorization will remain in effect until the completion date (last session month) of my massage package. By Signing below, I agree to be bound by the terms detailed in this document. I have reviewed, understand, and agree to be bound by all terms and conditions described. I certify that I am of sound mind, 18 or older.
Card Holders Full Name (Exactly as it appears on card): ________________________________________________
Card Holders Signature: ____________________________________________________ Date: ____________
SmileJellybean              P.O. Box 1066,        Sanger,           Texas             76266
SmileJellybean.com               940-206-9056              SmileJellybean @yahoo.com
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SmileJellybean
P.O. Box 1066
Sanger, TX. 76266