Recurring Payment Consent

You (“patient,” “you,” or “your”) agree to allow Zaghi Medical Inc. (“Shapely”) or an entity affiliated with Shapely to securely store your credit card or debit card (“Payment Method”) information. You authorize the Payment Method to be used automatically for any charges that are your responsibility including the Shapely monthly subscription fee, the cost of lab testing, the cost of medications, and the cost of any equipment or supplies you may need to care for your condition.

If you purchase a Shapely monthly subscription service, you acknowledge and agree that an automatic recurring payment will be made every month with monthly renewal of your subscription on a recurring basis.  The subscription is continuous and will be automatically renewed at the end of each month unless you cancel your subscription before the end of the then-current subscription period. If you cancel your subscription, your account will automatically close at the end of the current monthly billing period.

Shapely may change the price of your subscription from time to time and will communicate any price changes to you in advance and, if applicable, how to accept those price changes. Price changes will take effect at the start of the next monthly subscription period following the date of the price change. Subject to applicable law, you accept the new price by continuing to use the Shapely products and services after the price change takes effect. If you do not agree with a price change, you have the right to reject the change by unsubscribing from the services prior to the price change going into effect.

You have the right to withdraw your consent to this automatic recurring payment at any time. You can cancel your automatic recurring payment by emailing us at hello@getshapely.com or calling us at (424) 600-8360. You understand and acknowledge that services may be cancelled or withheld if you revoke this authorization, and that you are still responsible for all charges incurred by you or otherwise owed to Shapely.  

If you would like to change your Payment Method, you may make the change by calling us at (424) 600-8360. If you believe a charge is incorrect, you agree to contact us at hello@getshapely.com or (424) 600-8360 to attempt resolution before initiating a chargeback. No refunds are issued for partial months of service. Refunds for erroneous charges are reviewed on a case-by-case basis.

By providing your credit card or debit card information, you agree that you have read and understand this Automatic Recurring Payment Authorization. You represent and warrant that (i) any credit card or debit card information you supply is true, correct and complete (ii) charges incurred by you will be honored by your credit card or debit card company, (iii) you will pay all charges incurred in the amounts posted, including any applicable taxes, and (iv) you are the person in whose name the credit card or debit card was issued and you are authorized to make a purchase or other transaction with the relevant Payment Method. In addition, you authorize Shapely to charge the full monthly subscription amount and any other amounts owed by you to Shapely to the specified Payment Method; and you authorize the financial institution for the Payment Method to charge or debit your account and remit payment to Shapely. You further acknowledge and agree that you will not dispute the payment with the credit card or debit card company, provided the transactions correspond to the terms indicated in this authorization form.

This authority will remain in effect until you give notification, as required under this authorization form to terminate this authorization.