Notify-Pro Registration
Type of Service / Tipo de Servicio
*
Please Select
Doctor
Other service provider / Otro Proveedor de Servicio
Specialty
This will be used for the text messages, emails and phone calls.
Especialidad
Esto sera utilizado en mensajes de texto, emails y llamadas telefónicas.
Full Name / Nombre Completo
*
First Name
Last Name
E-mail
*
example@example.com
Cellphone / Numero de teléfono celular
*
Email Subject / Titulo del Email
*
Logo (Regular)
Browse Files
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Choose a file
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of
Logo (Small size)
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of
My Products
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Pay As You Go
$15 monthly to keep your subscription active and at the end of your monthly cycle you will be charged 0.20 cents per token used.
$
15.00
for each
month
Basic Package
Includes 250 monthly tokens at a discounted rate - $50 monthly fee.
$
50.00
for each
month
Standard Package
Includes 500 monthly tokens at a discounted rate - $90 monthly fee.
$
90.00
for each
month
Premium Package
Includes 1000 monthly tokens at a discounted rate - $160 monthly fee.
$
160.00
for each
month
Pro Package
Includes 2000 monthly tokens at a discounted rate - $300 monthly fee.
$
300.00
for each
month
Ultimate Package
Includes 5000 monthly tokens at a discounted rate - $750 monthly fee.
$
750.00
for each
month
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Selected Package:
Summary of selected package:
Selected Package:
Selected Package:
Selected Package:
Selected Package:
Selected Package:
Your selected package has:
*Unlimited use of tokens monthly, then you will be charged for used tokens every 30 days.
Your selected package includes:
Your selected package includes:
Your selected package includes:
Your selected package includes:
Your selected package includes:
*Tokens per 30 days cycle.
Signature
*
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