Please complete this form ONLY if you wish to set up recurring payments for monthly use of the CryoLounge+ forms.
If you wish to pay for one session or one month, please visit the customer service center.
I understand that I am paying for use of the CryoLounge+ located in the recovery room in the Adult Locker Room. The monthly recurring fee of $18 allows use of the CryoLounge+ for up to 15 minutes daily.
If I wish to terminate my use of the CryoLounge+ and stop automatic recurring payments, I will inform the Levine JCC in writing 30 days prior to the termination date (the last day of the month). I further understand that the authority of this payment authorization will remain in effect until the payment period indicated in this form or until my written termination is received by the Levine JCC. I agree the Levine JCC shall be fully protected in honoring such drafts or credit card debits.
I understand I will not be provided with a code to use the CryoLounge+ until such time as I have a payment method on file.