(Client’s Last Name) (First) (Initial) (Phone)
(Address) (City) (State) (Zip)
I wish to purchase from (the “Company”) the Program described herein and enter into the following agreement (the “Agreement”).
EXT™ Extreme Hair Therapy (the “Program”) is a scientific approach to hair and scalp care, which combines the latest available technology in hair care products, dietary supplements, chlorine-free water, and a proper diet.
The term of the program is twelve (12) months for clients whose goal it is to improve the appearance of thin-looking hair by creating a healthy environment in which hair may re-grow.
The Program consists of the following phases:
PHASE One – Months 1 – 2
Initial EXT™ Treatment Schedule: 4 Treatments
Monthly: The client will receive:
· Two EXT™ Hair Care Treatments per month
· One Hair Cut and Styling per month
· One Hair Analysis per month
Initial EXT™ Hair Care Products included:
· One each Chlorine-Free Shower Filter
· One Bottle of the EXT™ Revitalizing Cleanser Shampoo
· One Bottle of the EXT™ Enzyme Scalp Cleanser
· One Bottle of the EXT™ Energizing Conditioner
· One 2.0 oz. Bottle of EXT™ Minoxidil
· One Bottle of EXT™ Revitalizing Complex
PHASE Two – Months 3 – 12
Monthly EXT™ Treatment Schedule: 10 Treatments
Monthly: The client will receive:
· One EXT™ Hair Care Treatment per month
· One Hair Cut and Styling per month
· One Hair Analysis per month
PRODUCTS
Monthly EXT™ Hair Care Products included:
· One Bottle of the EXT™ Revitalizing Cleanser Shampoo
· One Bottle of the EXT™ Enzyme Scalp Cleanser
· One Bottle of the EXT™ Energizing Conditioner
· One 2.0 oz. Bottles of EXT™ Minoxidil
· One Bottle of EXT™ Revitalizing Complex
To achieve maximum benefits from the Program, you should adhere to the regimens and treatments prescribed above.
It is recommended that upon completion of this Program, the Client shall continue to care for his or her hair using EXT™ Hair Revitalizing Products. In addition to the Program, you may purchase additional EXT™ Hair Care Treatments not included with the Program for $95 per treatment.
I acknowledge that it may take a minimum of four (4) months for the average client to improve the condition of their scalp, and to improve the appearance of thin-looking hair.
Upon expiration of this Agreement, you may enter into a new Agreement for a term of twelve months. See your Hair Club Sales Professional for details.
DISCLAIMER: I ACKNOWLEDGE THAT THE COMPANY HAS OFFERED NO ASSURANCES OR GUARANTEES OF ANY KIND. I REALIZE THAT THE COMPANY’S STATEMENTS DESCRIBING THE BENEFITS AND ATTRIBUTES OF THE PROGRAM ARE ACCURATE ONLY WHEN RELATED TO THE AVEARAGE CLIENT BUT INDIVIDUAL RESULTS MAY VARY. I UNDERSTAND THAT THE PROGRAM IS A HAIR LOSS PREVENTION PROGRAM AND SOME CLIENTS WILL NOT EXPERIENCE HAIR RE-GROWTH.
HCM 105 EXT 1st Year – Revised 12/04
If for any reason I feel that Extreme Hair Therapy has not resulted in a cosmetic improvement over my current hair loss situation, HCMW will apply my initial purchase price toward any other hair loss solutions, which they provide (See Consultant for details).
While the current research indicates that the Program is safe, I accept full responsibility for any complications which may arise as a result of the Program. (Note: If you are pregnant or suspect that you may be pregnant, you should not participate in this Program. It is your responsibility to advise the Company if you become pregnant while participating in the Program. I hereby acknowledge that at the present time I am not pregnant and that I will advise the Company in the event that I become pregnant while participating in the Program. )
I acknowledge that, during my consultation, the entire process was explained to me in detail. I was given ample opportunity to ask questions about the process and all questions were answered to my complete satisfaction.
I understand that this agreement shall be governed and construed in accordance with the laws of the state of without giving effect to principles of conflicts of law.
If any provision in this agreement is held invalid or otherwise unenforceable by any court or other government authority, or in any proceeding, such findings shall not invalidate the remainder of the agreement, and the remainder of the agreement shall be enforceable by its terms. This agreement may not be amended, and its terms may not be waived, except by a written document signed by the parties.
I may cancel this Agreement by notifying the Company, in writing, postmarked within three (3) business days from the date of this Agreement. I will be entitled to a full refund of all money paid by me to the Company under this Agreement.
I understand that my agreed upon total price is the final price and that any rebates, promotions or discounts which the Company may offer in the future are not applicable. I further understand that all fees are non-refundable.
Twelve-Month EXT™ Treatment Program
Purchase Price $
Adjustment $
Sub Total $ 0.00
Sales Tax % $ 0.00
Total Price $ 0.00
Deposit Amount () $
Balance Due $ 0.00
Program Starting Date:
Client Signature:______
HCMW Signature:______
Center: HCMW of Boston Date: 1/20/2011
My signature indicates that I have requested and hereby consent to the EXT™ Extreme Hair Therapy Program and have read, understand and accept all of the above terms and conditions of this agreement.