Common use of PLEASE COMPLETE THE INFORMATION BELOW Clause in Contracts

PLEASE COMPLETE THE INFORMATION BELOW. I _____________________________________ authorize Harts Events to immediately charge my credit account a date-hold deposit equal to half of my standard rental fee. This payment is for my event on ____________________________. The remainder balance will also be charged to this card if other payment arrangements have not been made within 2 business days of your event. If you would like to use an alternative payment method (check, additional credit card, cash) for the space rental fees balance, bar costs, catering, equipment, furniture, and/or miscellaneous costs, please check here . Please note that if you choose to use an alternative form of payment, payment timeframe remains the same. if the alternative method of payment has not been received by the due date the original credit card will be charged.  Check _________  VISA  MASTERCARD  DISCOVER  AMEX Credit Card Number: Expiration Date: Security Code: Name: (as it appears on card) Billing Address: Please note: All transactions will be subject to a 2.75% processing fee for Visa, Discover, Mastercard, and American Express. SIGNATURE _________________________________________________ DATE __________________ . I authorize Xxxx'x Events to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the event described above. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. Alcohol Policy All local, state, and federal laws concerning the serving and consumption of alcohol will be strictly enforced and are the sole obligation of the Client A client- hosted NON cash bar may be provided for your guests. Absolutle no monies may be tendered for alcohol dispursed at your event. Drink tickets may be sold prior to the event. No alcoholic beverages will be served to anyone under the age of 21 at any time. A preapproved, insured bar tending service must dispense all alcoholic beverages unless the Client signs the liability declaration assuming all liabilities solely from this event. If using a bartending service a copy of their Liquor Liability Insurance must be submitted prior to the event date. No alcoholic beverages are allowed outside of the venue hall at any time. Drunkenness wil not be tolerated and violators will be asked to leave the property. Failure to abide by this Alcohol policy may result in the event immediately being terminated and forfeiture of Damage deposit. All bar service is required to end thirty (30) minutes prior to the end of your rental period. I agree to comply with the above rules and bear responsibility for the event and my attendees. If any problems shoild arise related to my event, I will fully support any decision by Harts Events to resolve the issues. I further agree to hold Harts Events, its employees, and owners harmless from any and all liability as a result of this event. ______________________________________ ______________ Client Signature Date Food Policy All food must be provided by a licensened and insured caterer unless Client signs liability declaration. If using a caterer proof of insurance must be presented prior to the event date and the caterer must sign a hold harmless agreement accepting all food liabilities prior to the event. All food must be prepared offsite. No onsite cooking is permitted. Chafing Dishes with sternos are permitted and client assumes all liability for any damages caused by heating methods of food. No electrical heating methods are permitted. I agree to comply with the above rules and bear responsibility for the event and my attendees. This includes sickness, injury of any attendees or damages to Harts Events property. I agree to hold Harts Events, its employees, and owners harmless from any and all liability as a result of this event. ________________________________________ _________________

PLEASE COMPLETE THE INFORMATION BELOW. I _____________________________________ (full name) authorize Harts Events BN Counseling, LLC to immediately charge my credit account a date-hold deposit equal to half card as payment indicated below for scheduled appointments for payment of my standard rental feesessions/co-payment/co-insurance/deductible. This payment is These charges include full payments for my event on ____________________________missed appointment unless otherwise negotiated. The remainder balance will also be charged to this card if other payment arrangements have not been made within 2 business days of your event. If you would like to use an alternative payment method (check, additional credit card, cash) for the space rental fees balance, bar costs, catering, equipment, furniture, and/or miscellaneous costs, please check here . Please note that if you choose to use an alternative form of payment, payment timeframe remains the same. if the alternative method of payment has not been received by the due date the original credit card will be charged.  Check _________  VISA  MASTERCARD  DISCOVER  AMEX Credit Card Number: Expiration Date: Security Code: Name: (as it appears on card) Billing Address: Please noteCity State Zip Phone#: All transactions Email: CREDIT CARD: Visa Master Amex Discover Other: Cardholder Name: Account Number: Exp. Date: CVV (AMEX 4 digit number front of card) SIGNATURE DATE I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify BN Counseling, LLC in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that BN Counseling, LLC may at its discretion attempt to process the charge again within 30 days, and agree to an additional $30 charge for each attempt returned NSF which will be subject to initiated as a 2.75% processing fee for Visa, Discover, Mastercard, and American Express. SIGNATURE _________________________________________________ DATE __________________ separate transaction from the authorized recurring payment. I authorize Xxxx'x Events acknowledge that the origination of ACH transactions to charge my account must comply with the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the event described aboveprovisions of U.S. law. I certify that I am an authorized user of this credit card card/bank account and that I will not dispute the payment these scheduled transactions with my credit bank or cr edit card company; so long as the transaction corresponds transactions correspond to the terms indicated in this authorization form. Alcohol Policy All localNO CANCELLATION PAYMENT POL ICY INS URANCE О MISSED APPOINTMENT FEES {Our relationship with money and time reflects how we value ourselves and others} Thank you for choosing us as your wellness provider. While your wellness is our priority, statewe still must cover this often uncomfortable topic about payments & missed appointments. Kindly take time to read each statement and initial that you acknowledge and agree. Thank you. Initial MISSED APPOINTMENTS. Rescheduling is preferred over cancellation. Weekly standing appointments are what we call “your time” meaning that we will honor “your time” in expectation of rendering you professional & courteous service for your scheduled appointment. Scheduling of an appointment involves the reservation of time specifically for you, and federal laws concerning the serving and consumption a minimum of alcohol 48 hours notice is required for re-scheduling an appointment. If you miss or do not show up at “your time,” please be aware that you will be strictly enforced and are the sole obligation charged a cancellation fee of the Client A client- hosted NON cash bar may be provided $80.00 for your guestseach missed/no-show therapy session including missed rescheduled appointments. Absolutle no monies may be tendered Insurance health plans do not pay for alcohol dispursed at your event. Drink tickets may be sold prior to the event. No alcoholic beverages missed appointments; these charges will be served entirely your responsibility. We understand that on rare occasions, true emergencies may arise. We will do our absolute best to anyone under the age of 21 at any timeassist with rescheduling paid missed sessions due to true emergencies. A preapproved, insured bar tending service must dispense all alcoholic beverages unless the Client signs the liability declaration assuming all liabilities solely from this event. If using a bartending service a copy of their Liquor Liability Insurance must be submitted prior to the event date. No alcoholic beverages Rescheduling appointments are allowed outside of the venue hall at any time. Drunkenness wil not be tolerated and violators will be asked to leave the property. Failure to abide by this Alcohol policy may result in the event immediately being terminated and forfeiture of Damage deposit. All bar service is required to end thirty (30) minutes prior to the end of your rental period. I agree to comply with the above rules and bear responsibility highly dependent on availability that mutually converges for the event client and my attendeescounselor. If any problems shoild arise related to my event, I We will fully support any decision by Harts Events to resolve the issues. I further agree to hold Harts Events, its employees, and owners harmless from any and all liability however offer only 2 make-up opportunities as a result of this eventcourtesy for paid missed sessions. ______________________________________ ______________ Client Signature Date Food Policy All food must be provided by a licensened and insured caterer unless Client signs liability declaration. If using a caterer proof of insurance must be presented prior to the event date and the caterer must sign a hold harmless agreement accepting all food liabilities prior to the event. All food must be prepared offsite. No onsite cooking is permitted. Chafing Dishes with sternos are permitted and client assumes all liability for any damages caused by heating methods of food. No electrical heating methods are permitted. I agree to comply with the above rules and bear responsibility for the event and my attendees. This includes sickness, injury of any attendees or damages to Harts Events property. I agree to hold Harts Events, its employees, and owners harmless from any and all liability as a result of this event. ________________________________________ _________________Rescheduled sessions DO NOT replace already scheduled weekly appointments.

PLEASE COMPLETE THE INFORMATION BELOW. I _____________________________________ authorize Harts Events to immediately charge my credit account a date-hold deposit equal to half of my standard rental fee. This payment is for my event on ____________________________. The remainder balance will also be charged to this card if other payment arrangements have not been made within 2 business days of your event. If you would like to use an alternative payment method (check, additional credit card, cash) for the space rental fees balance, bar costs, catering, equipment, furniture, and/or miscellaneous costs, please check here . Please note that if you choose to use an alternative form of payment, payment timeframe remains the same. if the alternative method of payment has not been received by the due date the original credit card will be charged.  Check _________  VISA  MASTERCARD  DISCOVER  AMEX Credit Card Number: Expiration Date: Security Code: Name: (as it appears on card) Billing Address: Please note: All transactions will be subject to a 2.75% processing fee for Visa, Discover, Mastercard, and American Express. SIGNATURE _________________________________________________ DATE __________________ . I authorize Xxxx'x Events to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the event described above. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. Alcohol Policy All local, state, and federal laws concerning the serving and consumption of alcohol will be strictly enforced and are the sole obligation of the Client A client- hosted NON cash bar may be provided for your guests. Absolutle no monies may be tendered for alcohol dispursed at your event. Drink tickets may be sold prior to the event. No alcoholic beverages will be served to anyone under the age of 21 at any time. A preapproved, insured bar tending service must dispense all alcoholic beverages unless the Client signs the liability declaration assuming all liabilities solely from this event. If using a bartending service a copy of their Liquor Liability Insurance must be submitted prior to the event date. No alcoholic beverages are allowed outside of the venue hall at any time. Drunkenness wil not be tolerated and violators will be asked to leave the property. Failure to abide by this Alcohol policy may result in the event immediately being terminated and forfeiture of Damage deposit. All bar service is required to end thirty (30) minutes prior to the end of your rental period. I agree to comply with the above rules and bear responsibility for the event and my attendees. If any problems shoild arise related to my event, I will fully support any decision by Harts Xxxxx Events to resolve the issues. I further agree to hold Harts Events, its employees, and owners harmless from any and all liability as a result of this event. ______________________________________ ______________ Client Signature Date Food Policy All food must be provided by a licensened and insured caterer unless Client signs liability declaration. If using a caterer proof of insurance must be presented prior to the event date and the caterer must sign a hold harmless agreement accepting all food liabilities prior to the event. All food must be prepared offsite. No onsite cooking is permitted. Chafing Dishes with sternos are permitted and client assumes all liability for any damages caused by heating methods of food. No electrical heating methods are permitted. I agree to comply with the above rules and bear responsibility for the event and my attendees. This includes sickness, injury of any attendees or damages to Harts Events property. I agree to hold Harts Events, its employees, and owners harmless from any and all liability as a result of this event. ________________________________________ _________________

PLEASE COMPLETE THE INFORMATION BELOW. I _____________________________________ (full name) authorize Harts Events BN Counseling, LLC to immediately charge my credit account a date-hold deposit equal to half card as payment indicated below for scheduled appointments for payment of my standard rental feesessions/co-payment/co-insurance/deductible. This payment is These charges include full payments for my event on ____________________________missed appointment unless otherwise negotiated. The remainder balance will also be charged to this card if other payment arrangements have not been made within 2 business days of your event. If you would like to use an alternative payment method (check, additional credit card, cash) for the space rental fees balance, bar costs, catering, equipment, furniture, and/or miscellaneous costs, please check here . Please note that if you choose to use an alternative form of payment, payment timeframe remains the same. if the alternative method of payment has not been received by the due date the original credit card will be charged.  Check _________  VISA  MASTERCARD  DISCOVER  AMEX Credit Card Number: Expiration Date: Security Code: Name: (as it appears on card) Billing Address: Please noteCity State Zip Phone#: All transactions Email: CREDIT CARD: Visa Master Amex Discover Other: Cardholder Name: Account Number: Exp. Date: CVV (AMEX 4 digit number front of card) SIGNATURE DATE I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify BN Counseling, LLC in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that BN Counseling, LLC may at its discretion attempt to process the charge again within 30 days, and agree to an additional $30 charge for each attempt returned NSF which will be subject to initiated as a 2.75% processing fee for Visa, Discover, Mastercard, and American Express. SIGNATURE _________________________________________________ DATE __________________ separate transaction from the authorized recurring payment. I authorize Xxxx'x Events acknowledge that the origination of ACH transactions to charge my account must comply with the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the event described aboveprovisions of U.S. law. I certify that I am an authorized user of this credit card card/bank account and that I will not dispute the payment these scheduled transactions with my bank or credit card company; so long as the transaction corresponds transactions correspond to the terms indicated in this authorization form. Alcohol Policy All localNO CANCELLATION PAYMENT POL ICY INSURANCE О MISSED APPOINTMENT FEES {Our relationship with money and time reflects how we value ourselves and others} Thank you for choosing us as your wellness provider. While your wellness is our priority, statewe still must cover this often uncomfortable topic about payments & missed appointments. Kindly take time to read each statement and initial that you acknowledge and agree. Thank you. Initial MISSED APPOINTMENTS. Rescheduling is preferred over cancellation. Weekly standing appointments are what we call “your time” meaning that we will honor “your time” in expectation of rendering you professional & courteous service for your scheduled appointment. Scheduling of an appointment involves the reservation of time specifically for you, and federal laws concerning the serving and consumption a minimum of alcohol 48 hours notice is required for re-scheduling an appointment. If you miss or do not show up at “your time,” please be aware that you will be strictly enforced and are the sole obligation charged a cancellation fee of the Client A client- hosted NON cash bar may be provided $80.00 for your guestseach missed/no-show therapy session including missed rescheduled appointments. Absolutle no monies may be tendered Insurance health plans do not pay for alcohol dispursed at your event. Drink tickets may be sold prior to the event. No alcoholic beverages missed appointments; these charges will be served entirely your responsibility. We understand that on rare occasions, true emergencies may arise. We will do our absolute best to anyone under the age of 21 at any timeassist with rescheduling paid missed sessions due to true emergencies. A preapproved, insured bar tending service must dispense all alcoholic beverages unless the Client signs the liability declaration assuming all liabilities solely from this event. If using a bartending service a copy of their Liquor Liability Insurance must be submitted prior to the event date. No alcoholic beverages Rescheduling appointments are allowed outside of the venue hall at any time. Drunkenness wil not be tolerated and violators will be asked to leave the property. Failure to abide by this Alcohol policy may result in the event immediately being terminated and forfeiture of Damage deposit. All bar service is required to end thirty (30) minutes prior to the end of your rental period. I agree to comply with the above rules and bear responsibility highly dependent on availability that mutually converges for the event client and my attendeescounselor. If any problems shoild arise related to my event, I We will fully support any decision by Harts Events to resolve the issues. I further agree to hold Harts Events, its employees, and owners harmless from any and all liability however offer only 2 make-up opportunities as a result of this eventcourtesy for paid missed sessions. ______________________________________ ______________ Client Signature Date Food Policy All food must be provided by a licensened and insured caterer unless Client signs liability declaration. If using a caterer proof of insurance must be presented prior to the event date and the caterer must sign a hold harmless agreement accepting all food liabilities prior to the event. All food must be prepared offsite. No onsite cooking is permitted. Chafing Dishes with sternos are permitted and client assumes all liability for any damages caused by heating methods of food. No electrical heating methods are permitted. I agree to comply with the above rules and bear responsibility for the event and my attendees. This includes sickness, injury of any attendees or damages to Harts Events property. I agree to hold Harts Events, its employees, and owners harmless from any and all liability as a result of this event. ________________________________________ _________________Rescheduled sessions DO NOT replace already scheduled weekly appointments.