OP Sober Living Fees for Housing

OP Sober Living Housing Fees

Fees for OP Sober Living; Summit Behavioral Health of AZ, DBA Granite Mountain Behavioral Healthcare.
What is the Payment For?

Other
What Days is this covering Fees for; Start and End date only:
Additional Explanation of Payment- What is the money for (If Needed)?
PAYEE: Name of person putting money through this form

First NameLast Name
Sober Living Member Name: Money is for Whom?

First NameLast Name
Payee E-mail
example@example.com
Payee Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which House does the Sober Living Member live in:

Other
Any additional Details: (if needed)
Please note that Granite Mountain Behavioral Health Care is a Summit Behavioral Health of AZ Company. Thus the invoice or email recieved may indicate the Summit Behavioral Health of AZ company name. If there are any issues with this transaction or form, feel free to call the form moderator Ben Isenberg @ 928-710-7021. If a Refund is needed, you will need to contact Ben as well. All refunds may take 72 hours+ to return back to the bank account the funds were transferred from.

Thank you!
Dollar amount for this Transaction

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USDOP Sober Living Fees

Debit or Credit Card

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OP Sober Living Housing Fees