Coaching Agreement and Credit Card Information
FAX-able Credit Card Information. Do not send sensitive information through e-mail. 

PRINT THIS PAGE AND FAX TO:
Rebecca Hanson: 561.828.3786

NOTE: This transaction will be billed on your credit card statement as Law of Attraction Resources. 

First name: ___________________________

Last name:__________________________

Address:_____________________________

City:_________________________________

State/Province:________________________

Zip/PostalCode:_______________________

Country:______________________________

Phone:_______________________________

E-mail: _______________________________
(So you will get a receipt)

 

Card information:

Select a Coaching Package:
Package
# Hours
Total
A
3 hours of LOA*

$600 US
*LOA=Law of Attraction

Name on card: _________________________
(if not the same)

Card Number: __________________________

Card Type: Visa MasterCard AMEX Discover

Expiration date: _______Month _________Year

 

X____________________________ Your Signature