Resident Salon Service Requests and Payment Set-Up
For residents that do not have access to their own funds we offer 2 options for paying for services. One option is keeping a credit card on file in our secure system thru the office of Milestone Salon Services. The card on file will be charged bi-monthly with our billing cycle. The other payment option is to be sent a monthly bill. If you prefer this, then you will need to sign a billing agreement and will receive a monthly invoice for the previous month. Please fill this form out to get your payment choice set up.  
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Name of Resident *
Community Resident Lives In *
Name of Person Responsible for Payments *
Best Contact Phone Number *
Please select Payment Method if you choose to billed please note, the bill is due immediately. If it is not paid with in 15 days there could be a $10 late fee, *
Service(s) Requesting, Please be specific if you have not communicated with the salon provider yet.  For example, a shampoo set weekly, haircut every 6 weeks.  For appointments please call the stylist at the location. See the last section on this form for phone number. *
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