Products Price Quantity Total

Products		Price	Quantity	Total
Session Deposit: Comprehensive Health Breakthrough	$300.00	Update	$300.00
Subtotal			$300.00

Session Deposit: Comprehensive Health Breakthrough

$300.00

Update

$300.00

Subtotal $300.00

PLEASE NOTE: You will pay the $300 deposit now and the additional amount at the time of your scheduled appointment. Total cost for a Comprehensive Health Breakthrough Session is $995

Billing Information

* First Name

* Last Name

Company Name

* Address - Line 1

Address - Line 2

* City

* State

* Zip Code

* Country

* Phone Number

* Email Address

Order Summary

Subtotal $300.00

Order total $300.00

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Credit card
Card type	Card number	Expiration Date	CVC

Payment Information

Credit card

Card type

Card number

Expiration Date

CVC

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