Payment Plan: Lima
Card Number:
Expiration Month
Expiration Year
CVV 3-digit
Billing Street Address for Card
Billing ZIP for Card
Name on Card
*SIGNATURE: My typed name below constitutes my signature and agreement that my above Card may be auto-charged in the discounted amount of $997 per month, beginning January 21, 2026 and continuing on the same calendar day of each consecutive subsequent month, for a grand total of FOUR (4) payments:
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