zingfit Stripe Terminal Order Form

1. Are you authorized to place orders on behalf of the business? * *This question is required.

2. Your Name *This question is required.

3. Your Email Address *This question is required. This question requires a valid email address.

5. How many Stripe terminals would you like to order and ship to the shipping address listed below? *

The cost of terminals varies by model and country. The WisePOS E terminal is $249US / CA$200 / £179.00 (available in the US, UK and Canada). Shipping and handling is additional. *This question is required.

Billing Information

6. Brand Name *This question is required.

7. Which studio should be billed for the terminals + shipping and handling? (Please name ONE and we will use the billing information on file for that studio.) * *This question is required.

Shipping information

Please note that a signature will be required. The phone number you provide will be shared with Stripe and the shipping company.

8. Shipping Method *This question is required.

9. Recipient's name *This question is required.

10. Recipient's phone number *This question is required.

11. Street address *This question is required.

12. Address line 2

13. City *This question is required.

14. State/Province *This question is required.

15. Country *This question is required.

16. ZIP Code *This question is required.

17. Additional Notes

Billing authorization

18. Your Zingfit representative will call you to get your credit card information. Zingfit will place the terminal order(s) on your behalf, using the card provided. Payment is required before Zingfit submits your order to Stripe. Please note that the Stripe terminal is non-refundable. *This question is required.

I understand

19. Please sign to authorize zingfit to order your terminals + shipping and handling. *
*This question is required.

Clear

Signature of

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the Company in writing of any changes in my account information or termination of this authorization at least 30 days prior to the next billing date.If the payment due dates fall on a weekend or holiday, I understand that the payment may be executed on the prior day. I understand that because this is an electronic transaction, these funds will be withdrawn from my account as soon as the payment is due. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that the Company may at its discretion attempt to process the charge again, and agree to an additional $25 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized payment.I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms agreed upon with the Company.