Full Name
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Email
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Phone
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Total Amount For Prepayment (total must be paid before session date)
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How Many Payments Do You Want To Split It Into?
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When Would You Like Your Payments To Be Due?
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One Time
Every 7 Days
Every 14 Days
Every 30 Days
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Amount To Be Drafted For Each Payment (tax may be added)
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List Your Prepayment Gifts Selection
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When Do You Want To Make Your First Payment?
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Would You Like To Discuss Over A Phone Call?
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Yes
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Any Additional Comments
Do you acknowledge that any payments are non refundable and that all payments will be automatically drafted from your payment method?
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Yes
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