Enrollment (Pro Consultant) January 1, 2020by VIVPros Enrollment (Pro Consultant) Share Please enable JavaScript in your browser to complete this form.PERSONAL INFORMATIONName *FirstMiddleLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *EmailConfirm EmailCell Phone *Home PhonePRO CONSULTANT CONFIRMATION DETAILSDate of Birth *Example: MM/DD/YYYYPAYMENT INFORMATIONYou'll only be charged $189.98 today. This includes a 50% discount on the $99 per year (only $50 today) plus your first and last on the $69.99 monthly subscription. In other words: $50 today + $69.99 first + 69.99 last = $189.98 Total Paid Today. Each year, on the anniversary of your enrollment, you'll automatically be charged a $99 renewal fee to keep your account active, billed to the credit card you provide today. Your monthly subscription price is $69.99 per month starting your second month, billed to the credit card you provide today, until you cancel. You can cancel anytime by calling (833) 848-5433.Credit Card Number *Name On The Credit Card *Expiration Date *Example: 10/25CVV *The 3 or 4 digit code on the back of the Credit CardIs The Billing Address The Same As Above? *Please select oneYesNoBilling AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCONFIRM CURRENT & RECURRING FUTURE PAYMENTSYou'll be charged $189.98 today. This includes a 50% discount on the $99 per year enrollment (only $50 today) plus your first and last on the $69.99 monthly subscription. Each year, on the anniversary of your enrollment, you'll automatically be charged a $99 renewal fee to keep your account active, billed to the credit card you provide today. Your monthly subscription price is $69.99 per month starting your second month, billed to the credit card you provide today, until you cancel. You can cancel anytime by calling (833) 848-5433. *I AgreeEnrollment Confirmation Disclaimer and Acknowledgement *FirstMiddleLastI UNDERSTAND THAT THERE ARE NO REFUNDS. I understand that my IP Address is recorded for Fraud Protection. I certify that the above information contained in this enrollment is correct. I certify that I am authorized to use the above Credit Card information contained in this enrollment. I agree to abide by the rules and regulations of the company and never make any false claims to my customers.CommentSubmit Enrollment
