Credit Card Authorization Form

Credit Card Authorization Form

180° LOVE COACH
Cardholder Name

First NameLast Name
ConditionText
I, {cardholderName}, as a cardholder, hereby authorize 180° MARRIAGE RULE COACHING, LLC. to charge my credit card for COACHING SERVICES and confirm that the information for the credit card and billing address is complete and accurate.

I have been informed that I can cancel the recurring payment at least 15 days before the payment by phone or signing a consent form provided by the merchant company.
Date

MonthDayYear
Date
Cardholder Signature

Powered by Jotform SignClear
My Products*
Sort By

Name: A to Z

Name: Z to A

Price: Low to High

Price: High to Low

Clear Sort
prevnext( X )
One Time Payment
Consultation/Couple's Assessment : 1 Session

$120.00



Monthly Payment
Master Christian Life Coaching Session: Online coaching- 4 sessions

$240.00



Quarterly Payment
Master Christian Life Coaching Session: Online Coaching- 12 sessions.

$360.00



Yearly Payment
Master Christian Life Coaching Session: 4 session a month for a year.

$1,440.00



One Time Payment
Symbis Marriage Facilitator Overview: 2 Sessions Bi-Weekly

$120.00 Quantity
Item subtotal:$0.00



One Time Payment
S.C.A.R.S : Self Care Always Releases Scars (Anger Management Coaching Class) helping client cope and process their feels giving them tools to deal with inner wounds that's causing them to be angry.

$240.00 Quantity



One Time Payment
S.C.A.R.S : Self Care Always Releases Scars Mental Health Coaching, per session.

$120.00 Quantity



One Time Payment
D.O.V.E : Deeper Offering Volition Everyday Spiritual Coaching: 2 Sessions Bi-Weekly

$120.00 Quantity



One Time Payment
Couple's Spiritual Bootcamp Workshop: Rebuilding communication with God and each other in your relationship.

$120.00 Quantity



One Time Payment
Dreamer Chaser Coaching: Personal Development, career setting goals, destiny changer coaching.

$120.00 Quantity



One Time Payment
Initial Consultation: Coaching Evaluation

$120.00 Quantity
Appointment
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
180° LOVE COACH

ZADORA CARTER
Take Profile Photo

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Credit Card Authorization Form

180° LOVE COACH