Sign Up a Monthly or Yearly Membership The package you have chosen: First Name* : Last Name* : Address * : City * : State * : Zip Code * : Cell # * : Primary E-mail Address * : Make, Model and Color of vehicle *: State *:AL AlabamaAK AlaskaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District Of ColumbiaFL FloridaGA GeorgiaHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaOH OhioOK OklahomaOR OregonPA PennsylvaniaRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Existing Damage on vehicle *: YesNo CC Number * : CC Exp Month* : e.g.:05 CC Exp Year* : e.g.: 2018 CC CVC* : e.g.:123 TERMS AND CONDITIONS The Monthly Unlimited Wash Club provides unlimited car washes (1 per day) in each month the membership is renewed, and can be cancelled by writing us at Wash N’ Go Attn: Cancellation,1225 N. Union Ave, Fergus Falls MN 56537 or send us an email at info@ferguswashngo.com subject heading: Cancellation 7 days in advance or use the online cancellation form. No refunds or credits will be given for partial periods for any Unlimited Wash Club program. Cannot be used in conjunction with any other discounts. Members may upgrade to a different wash and pay the difference at the time of wash. Wash N’ Go Inc. reserves the right to cancel, amend or change the program, including but not limited to the Membership fees, from time to time as necessary. Only the car listed on this form is eligible for the Wash Club and must have a barcode tag affixed to the vehicle. Any attempt to remove the tag will destroy the tag and prevent it from operating. Member must notify Wash N’ Go Inc. of any change in vehicle ownership. The credit card associated with this membership can and will be charged one time per month (on the anniversary date or nearest date depending on the number of days in any given month) the amount associated with the price of the service plus tax at the time it was purchased. In the event of your credit card being declined for any reason or expired we will make every attempt to contact you using the contact information you have provided on your sign‐up sheet. Until payment is received we reserve the right to deny any and all wash services. Membership is not valid for commercial vehicles or any vehicle that does not conform to our normal washes. Commercial vehicles or taxis are not allowed. If you wash a vehicle other than the membership vehicle, a $ 50.00 misuse fee plus the cost of the car wash select will be charged to your account. Other limitations may apply. The chosen package cannot be combined with any other package, discount or promotion. Any vehicle that is being washed will be subject to all rules and limitations of Wash N’ Go Inc. Wash N’ Go is not responsible for any damage to your vehicle from the use of our washes. I have read and agree to the terms and conditions of this program. Club membership is automatically billed to my credit card every month. Signature (press & hold down the left mouse button to sign or use your touch screen): [signature* signature-545 ] Data with a (*) are required Δ