Membership Renewal
by Debit/Credit Card
Please provide us with the following information below:
[contact-form to=’subscriptions@6beds.org,it@6beds.org’ subject=’Membership renewal subscription (Credit Card).’][contact-field label=’Licensee(s) Name’ type=’name’ required=’1’/][contact-field label=’Mobile | Contact Phone No.’ type=’text’ required=’1’/][contact-field label=’Fax No.’ type=’text’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Website’ type=’url’/][contact-field label=’Mailing Address’ type=’text’ required=’1’/][contact-field label=’Total RCFE Facilities You Operate’ type=’text’/][contact-field label=’Total ARF Facilities You Operate’ type=’text’/][contact-field label=’Facility Info: Name | Address | County’ type=’textarea’ required=’1’/][contact-field label=’Membership Subscription’ type=’radio’ required=’1′ options=’Annual – $600,Semi-Annual – $300,Quarterly – $150,Monthly – $50’/][contact-field label=’Credit Card No.’ type=’text’ required=’1’/][contact-field label=’Expiration’ type=’text’ required=’1’/][contact-field label=’CVV Code’ type=’text’ required=’1’/][contact-field label=’Name on Card’ type=’text’ required=’1’/][contact-field label=’Billing Address’ type=’textarea’ required=’1’/][contact-field label=’Comments’ type=’textarea’/][/contact-form]
PLEASE READ BEFORE SUBMITTING
By clicking SUBMIT above, I authorize 6Beds, Inc. to initiate a recurring debit/credit card payment as indicated in the “Membership Subscription” field above.
I understand that this authorization will remain in effect until I cancel it in writing. I agree to notify 6Beds, Inc. in writing of any changes in my account information or termination of this authorization at least 30 days prior to the next billing date. I understand that because this is an automatic electronic payment, these funds may be withdrawn from my account as soon as the noted periodic transaction dates. I acknowledge that the origination of automatic electronic payment to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this card and will not dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.
6BEDS is a Mutual Benefit NON-PROFIT Corporation. Part of the membership fee is tax-deductible (consult with your tax advisor). Membership fees are non-refundable. Thank you for supporting our industry.
Please allow up to 48 hours for us to process your debit/credit card subscription