Membership Credit Card Authorization Form
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
Best Contact Number
Select the membership you are interested in
Plump Pink Membership $100 / month
Plump Perfect Membership $200 / month
Plump Platinum Membership $250 / month
Card Holder Name (as shown on card)
Expiration Date (mm/yy)
Billing ZIP Code
I authorize Plump Cosmetics & Injectables to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account. I understand that memberships are for a 12 month period.
Check here if you agree with this statement and authorize recurring payments
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