Bloom Recovery Network
Balance Payoff
Client Name
*
First Name
Last Name
Email
Add email for a receipt confirmation of payment
Payment Options Below
ALL PROGRAMS MUST BE PAID IN FULL 7 DAYS PRIOR TO THE PROGRAM START DATE.
MAKE PAYMENT BELOW
Payment Amount
*
Payment Amount with Fee
Payment Total Charged
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next
( X )
USD
Payment towards balance is Total Charged minus 3.5%
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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