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Membership Form

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Visa®, MasterCard®, Discover® & Diners Club® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Cover the fee associated with this online transaction?
Cover the fee associated with this online transaction?

I authorize Keep Charlotte Beautiful to initiate, and my financial institution to honor, a one-time electronic debit from my bank account on the date, for the amount, and from the account listed.

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Your credit balance will cover
Your credit card will be charged
Your bank account will be charged
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