Ambassador Signup Form

November 10, 2020JJ WadeSponsorsNo comments

Credit Card Authorization and billing information

Name*
First Last
Billing Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone
Precision PJS all-in-one Leg Solution*
Price: $59.50 Quantity:
List how many units a month per customer.
Consent*
I authorize a recurring monthly charge against my credit card for the following amount of $59.50 per a unit  once every month until cancelled. There will be additional charges for shipping & handling plus sales tax if applicable
Credit Card Number*
Security Code*
3 digit code on back
Expiration Date*
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