Membership Signup Form THE VELVET LEAF CIGAR LOUNGE Membership Enrollment Packet Mailing Address: 6600 Sugarloaf Parkway, Ste. 400-268, Duluth, GA 30097 Email: Info@VelvetLeafCigar.com Website: www.VelvetLeafCigar.comWelcome to The Velvet Leaf A sanctuary where distinction meets relaxation. As a valued member, you join a circle of refined individuals who appreciate craftsmanship, culture, and conversation. We are honored to extend to you the privileges of membership in a space curated for the modern aficionado. This isn’t just a cigar lounge; you are joining a legacy — a lifestyle!AUTHORIZATION AGREEMENTMember Name (Print) *Locker NumberI {name-1}, hereby authorize The Velvet Leaf Cigar Lounge to facilitate the secure remittance of my membership dues from the account or credit card indicated below. I understand that all transactions shall comply with U.S. financial regulations and will be handled with the highest level of discretion. By joining, I acknowledge that my membership grants access to a cultivated environment dedicated to craftsmanship, camaraderie, and the timeless art of the cigar experience.Membership Selection *Bronze $75/MonthlySilver $125/MonthlyGold $250/MonthlyGold $2,500/YearlyCorporate $600/MonthlyCorporate $6,000/YearlyPERSONAL INFORMATIONAddress *CityState/ProvinceZIP / Postal codeEmail Address *Phone *MEMBER DETAILS Name you would like on locker *Lounge Access Code (fob#)Promotional Card (Last 4 Digits – Gold & Corporate Only)MEMBER’S AFFIRMATION OF UNDERSTANDINGI recognize that my membership privileges are extended exclusively to me and are nontransferable.I understand that all monthly or quarterly member credits are extended as a courtesy and expire at the close of the calendar year.I acknowledge that membership dues will be processed on the 28th of each month to ensure uninterrupted enjoyment of my privileges.I affirm that all membership dues are non-refundable, reflecting the exclusivity of The Velvet Leaf experience.I agree to uphold The Velvet Leaf’s standards of elegance and decorum through appropriate attire while on the premises.MEMBERSHIP TERMS & CONDITIONS This agreement remains in effect until The Velvet Leaf Cigar Lounge receives written or verbal notice of cancellation. To discontinue membership, written notice must be received no later than the 13th day of the month in which termination is requested. Members concluding their membership are required to return all assigned locker keys. Unreturned keys are subject to a $25 replacement fee. In the event of a declined transaction, a $20 insufficient-funds fee will apply. All credit-card transactions include a 3.5% processing fee. Membership dues are non-prorated and non-refundable. Auto-renewal billing occurs on the 28th of each month, and monthly or quarterly credits are refreshed by the first day of each period. Credits are intended for the member’s personal enjoyment and must be redeemed prior to expiration; any unused balance gracefully expires at the end of the term. • Member discounts may not be combined with promotional credits.Member Name (Print) *Last Four SSNDate *Signature *Start signing your signature hereYour browser does not support e-Signature field.Payment & Enrollment ConfirmationMembership Selection *Bronze $75/MonthlySilver $125/MonthlyGold $250/MonthlyGold $2,500/YearlyCorporate $600/MonthlyCorporate $6,000/YearlyCredit / Debit Card *Submit
