Member name*

Phone number*

Address*

City*

State*

ZIP*

Birth date

Email*

Membership Type*
XpressBestPremierPremier PlusFamily MembershipFamily Membership Plus

Vehicle make*

Model*

Year*

Licence #*

Only for Family Memberships

Vehicle make, Car #2

Model, Car #2

Year, Car #2

Licence #, Car #2

Vehicle make, Car #3

Model, Car #3

Year, Car #3

Licence #, Car #3

Automatic Funds Transfer: Customer Authorizes Elevon Payment Service’s pre-authorized payments by electronic funds transfer.I hereby authorize R and R Auto Spa, dba Mike’s Auto Spa, LLC to initiate Debit/Credit charges for my monthly membership for the amountlisted on this application.

Name*

Authorized amount*

Date*

I confirm that this form is valid without my signature and that I will complete my payment by phone or in person.

Spam Prevention