Leap Home Services | Membership

Membership Form

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Email Address:

Telephone:

Membership Agreement

I have read and agree to the Membership Agreement above.

Fees and Costs

TYPE/DESCRIPTION OF FEE	AMOUNT
Yearly Fee. This is automatically charged every year on the Member's credit card on file.	$120.00/Year
Dispatch Labor Fee. This includes travel time and 2 additional hours at the job site to complete the task for Member who has parking for LHS technician; 1.5 hours when Member has no parking in front of their residence or LHS would need to pay for metered parking	$120.00 per Dispatch
Additional Time. When more time is needed to complete the task after the first 2 hours/1.5 hours, LHS will charge the Member amount specified.	$60.00 per Hour

All fees are subject to change with 30 days advance notice to Client. All amounts are in $USD.

Recurring Credit Card Payment Authorization

Member authorizes regularly scheduled charges to Member’s credit card. Members will be charged in Exhibit A for each billing period. An email receipt for each payment may be provided to the Member and the charge will appear on the Member's credit card statement. Member agrees that no prior notification will be provided unless the date or amount changes, in which case Member will receive notice from LHS at least 10 days prior to the payment being collected.

credit card indicated below for the amount specified in Exhibit A on the date of this Agreement and each month thereafter.

Credit Card Billing Information

Card Holder Name:

Credit Card Number:

Expiration Date:

Expiration Year:

Secure ID:

Address same as above

Billing Address:

City:

State:

Zip:

I agree to the above Membership Enrollment contract, and I authorize LHS to charge my credit card indicated above for the amount specified in the Fees section starting today, and each month thereafter. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify LHS in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next or previous business day. I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this Credit Card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this authorization form.

Cardholder’s Signature: