DIY Corporate Program Wellness Agreement

Billing information

First name*

Last name*

Email*

We'll send your invoice and other important info to this email.

Country

Address*

Address line 2 (optional)

Zip code*

City*

State

This product is for someone else

Participant info

Name - First name*

Name - Last name*

Email*

Mailing Address

Country

Address*

Address line 2 (optional)

Zip code*

City*

State

Phone Number

Phone Number *

This is a gift

When would you like this gift to be delivered at?

Time zone: (GMT-05:00) Eastern Time (US & Canada)

Personal note to the gift recipient (optional)

If you want them to know who it's from, tell them here.

Your payment

Choose price

$397.00
only if paying by Credit card or PayPal to Lisa Fraley Legal Coach LLC

$414.00 in 2 payments
only if paying by Credit card

$428.00 in 4 payments
only if paying by Credit card

Have a coupon code?

Coupon code

Update

Schedule of payments

Due	Amount
Today	$207.00
Jul 2	$207.00

Today	$207.00
Jul 2	$207.00

Credit card

Card number*

Expiration

CVC code*

3-4 digit code (see where to find it)

All transactions are secured using 256-bit encryption.

I understand and agree to

Yes, please send me important news and special offers via email (recommended)

Simplero

DIY Corporate Program Wellness Agreement

Schedule of payments

Due	Amount
Today	$207.00
Jul 2	$207.00

Today	$207.00
Jul 2	$207.00