Reason for Terminating
---Cannot make it to the Spa/Salon frequently enoughMovingDissatisfied with servicesFinancial ReasonsMedical IssuesOther

Which location did your Passport membership originate?*
---DevonDoverMarltonPhiladelphia

I hereby request the termination of my Toppers PASSPORT Membership and understand this Termination Notice Form is subject to the Terms and Conditions of the PASSPORT Membership Agreement (“Membership Agreement”) entered into with Topper’s Salon & Health Spa, Inc.
I understand that the termination of my membership will become effective in accordance with the termination provisions of the Membership Agreement.