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Member contact and billing information for co.co.haus Private Office contract
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* Indicates required question
Email
*
Your email
Member Name
*
Your answer
Member e-mail
*
Your answer
Member Birth Date
MM
/
DD
/
YYYY
Member Billing Address
*
Your answer
Member Billing City, State
*
Your answer
Member Billing Zip Code
*
Your answer
Member phone number
*
Your answer
Company Name
*
Your answer
Billing e-mail
if different from member's e-mail
Your answer
Forwarding Address
If different from Billing Address, please include City, State and Zip Code
Your answer
Number of desks for this membership
*
If this is for Virtual Office or co.club please choose (option 1)
Choose
1
2
3
4
5
6+
Membership Contract Type
*
Month to Month
3 months (5% discount )
6 months (10% discount)
1 year (15% discount)
Membership Start Date
*
MM
/
DD
/
YYYY
How did you hear from us?
*
Facebook
Instagram
Google
Friend
Other:
Interested in 24/7 access to parking garage? $70/ month
*
Yes
No
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