Payment Form

Name *

First

Last

Email *

Reason For Payment *

Payment Amount *

Enter dollar amount example 25.95… Submit and you will be directed to PayPal to complete transaction. Subscriptions will be processed via Stripe secure credit card processing service.

Please note the content of your order or purchase and referral source if any. (Ex. Mindset Challenge Starts April 1st) *

Please note what you you are paying for so we can make sure you receive the correct order when purchasing products that need to be shipped or picked up.

Credit Card For Subscription Payment *

Card Number

Security Code

Name on Card

Expiration/

Credit card information required for monthly subscription payments.

Address For Shipment *

Address Line 1

Address Line 2

City

State

Zip Code

Adress where you want the product shipped. All orders are shipped out within 3-5 business days.

Signature *

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

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