Unlimited Wash Club Enrollment

NOTE: Once you fill out our enrollment form, we will be in touch to securely obtain your credit card payment information and start the membership.

Name*
Cell Phone*
Email*
Vehicle 1
Year*
Make*
Model*
Color*
Plate Number*
State*
Want to add a second vehicle?*
- YES
- NO
Vehicle 2
Year
Make
Model
Color
Plate Number
State
Choose Your Membership
Membership Choice*
TERMS AND CONDITIONS
The Monthly Unlimited Wash Club provides unlimited car washes for your assigned vehicle in each month the membership is renewed, and monthly memberships can be cancelled at any time by the cardholder. Cancellations must be received within 5 days of your anniversary date to avoid additional billing. 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, interior cleaning, or other add on and pay the difference at the time of wash. Cornhusker Auto Wash reserves the right to cancel, amend or change the program, including but not limited to the Membership fees, from time to time as necessary. Cornhusker Auto Wash reserves the right to close the business due to inclement weather, holidays, facility maintenance, and business upgrades. Only the vehicle(s) listed on this form are eligible for the Wash Club and must have our provided window cling affixed to the vehicle. I agree that 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 (tax included) at the time it was purchased. In the event of your credit card being declined, cancelled, or expiring you must contact us to update your information. Failure to do so may result in termination of this agreement. I have read and agree to the terms and conditions of this program. Cornhusker Auto Wash is authorized to automatically bill my credit card every month until I complete, sign, and turn in the approved Cancellation form.
Digital Signature*
Typing your full name constitutes a digital signature for this enrollment form.
Today's Date*
Date Format: MM slash DD slash YYYY

Unlimited Wash Club Enrollment

Vehicle 1

Vehicle 2

Choose Your Membership

TERMS AND CONDITIONS