BLAQUE Membership Application

Shared Space Access Only

Thank you for your interest in the BLAQUE Membership. Please complete this application in full. Submission does not guarantee approval.

What are you applying for *

If business, what is the business name?

State of Formation

Business EIN

Business Phone Number

Please enter a valid phone number.

Business Email

[email protected]

Title

Give a brief Description of your business

Full Name

Address

Street Address

City

State

Country

Postal Code

Personal Phone Number

Personal Email

Please upload a clear picture of your ID

Payment Information

First Name
Last Name
Credit Card Number
Security Code

Expiration Month

Expiration Year

Billing Address

Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code

Membership is a 12-month commitment.
Monthly fee: $150.00/month.
Billing occurs monthly for 12 months.
Membership provides shared amenity access only (no private office).
Room bookings must be submitted via the official booking form.

Please acknowledge:
I understand and agree to the 12-month membership commitment.
I understand membership fees are non-refundable.
I understand room access is subject to availability and must be scheduled.

Please click the box above to acknowledge that you understand

I certify that all information provided is accurate and that I agree to the Membership Agreement, including the 12-month term and billing obligations.

Signatures *

Clear

Date: *

BLAQUE Executive Suites