By electronically submitting this form, you agree to the terms and conditions said forth. Any questions or concerns should be addressed directly via email to or by telephone at (503) 224-6800. Upon completion of this form, a confirmation email will be sent to you within 24-48 hours notifying you of any additional information required, as well as providing you with a PDF copy of this form for your records.

Submission of this electronic agreement does not immediately enroll you into the Palaquin Perks Membership Program. Additional information may be required to verify your identity, including providing us with a copy of your valid driver’s license and the credit card you choose to use for your monthly auto-bill.

Please read the information provided below carefully and feel free to contact us with any questions.

The Palaquin Perks Program allows us to offer incredibly affordable massages in exchange for monthly payments for a period of one year, which we conveniently charge to your credit card through our auto-billing arrangement. Please review carefully the terms of the agreement below:

Membership in the Palaquin Perks Program entitles you to one 60-minute or 90-minute massage (depending on which term you sign up for) per calendar month. The Palaquin Perks Program is for one year. If you do not use one of your month’s massages, you can use that massage the next month or for the remainder of your membership in the Palaquin Perks Program.

When you enroll in the Palaquin Perks Program, your credit card will be charged a non-refundable $25 set-up fee as well as the initial monthly fee ($65 for the 60-minute program or $85 for the 90-minute program) which will be auto-billed on the first payment date of your membership agreement (either the 1st or the 15th of the month).

Any notice required by this agreement can be sent to Palaquin Massage one of three ways:

By physical mail to:

511 SW 10th Ave.
Suite 1108
Portland, OR 97205

By email to:

By phone at (503) 224-6800. Notification by phone call will be confirmed via email or mail.

It is your responsibility to use your massages. Palaquin Massage has no obligation to remind or inform you of any unused massages.

As part of the Palaquin Perks Program, Palaquin Massage automatically bills your credit card for the monthly payments. Please read each statement below with the terms listed:

Palaquin Massage will keep your credit card information on our secure electronic server. You will keep your address and credit card information current by promptly notifying Palaquin Massage of any changes to your mailing address or credit card information.

The Palaquin Perks Program has a minimum requirement of 12 months. If you wish to terminate prior to 6 months, you will need to pay the full price of $80 (for the 60-minute program) or $100 (for the 90-minute program) for any massages received at the discounted member rate, as well as a $25 early cancellation fee.

Cancellation of your membership after 6 months, but before the 12-month contract expiration date will incur a $100 early termination fee.

If you cancel your contract prior to the one year membership, you will have until the end of your cancellation month to use any unused Perks massages at the member rate. After the end of the cancellation month, all unused Perks massages turn into store credit at the discounted member rate to use toward any future massages at the full, non-membership price.

You may wish to freeze/suspend your Palaquin Perks Membership for up to 3 months due to extenuating circumstances only. During this period, you will be charged a $10 monthly maintenance fee in lieu of your standard membership rate. You will be unable to use any benefits during this time, however you will be able to resume your membership after the suspension period. Palaquin Massage reserves the right to refuse a request on a case by case basis.

Each month your credit card will be automatically charged the monthly installment fee. You can choose whether your card will be charged on the 1st or the 15th day of each month.

Your Palaquin Perks Membership will be auto-renewed after the one year agreement expires, on a month-to-month basis.

I understand that I am the only person who may use my Palaquin Perks Program massages. Members may gift one Perks massage per month with a $10/session transfer fee (limit 6 per 12-month agreement).

Palaquin Massage validates parking ONLY at the SmartPark located at 10th and SW Yamhill. Palaquin will validate up to 2 hours of parking per each 60- or 90-minute Perks massage. Parking is validated for all Perks massages and Additional Perks massages.

I understand that Palaquin Massage offers only store credit––no cash back or credit card returns.