Jump to Content
 

Available Forms

22) Beauty 12 Inquiry for Payment Plan

Beauty Payment Plan Inquiry

Home Towne Beauty (HTB) has monthly payment plan for your convenience. Please read the following regulations, sign below to accept, and then submit the inquiry to the Home Towne Beauty to expedite your plan.

Payments must be made with a credit or debit card. You are required to notify HTB in writing if you would like to switch payments to a different credit/debit card. This can be submitted electronically via the patient portal, email to htbeauty@myupdox.com or by mail to 15580 3rd Ave SW, Suite 101, Burien, WA 98166.

Your credit or debit card will be automatically charged on the day of each month you choose when activating the plan until the balance at the time of the payment plan is paid in full, the final payment may be less.

Payments will be automatically withdrawn on either the first or the 15 of the month.

If your payment is not received or unable to process (declined) the contract will no longer be valid and the amount is due in full immediately.

You may select multiple areas
Use this field if you have any questions.
 

Consent to contact me regarding a payment plan

I acknowledge that I am submitting an inquiring into payments plans for aesthetic services and permit a staff member at HTB to contact me for further information. I have read the HOME TOWNE BEAUTY's payment contract above and agree to each guideline.

This is your electronic signature.
* Required field