For Free Consultation
Call or Email us
+13213532991
info@centenarianlifestyle.com
Call us now!
+13213532991
Confirmation Form
Centenarian Lifestyle
>
Confirmation Form
Confirmation Form
Step
1
of
2
50%
Hidden
Next Steps: Install the Stripe Add-On
To accept payments on this form you will need to install the Stripe payment add-on. Important: Delete this tip before you publish the form.
Name
(Required)
First
Age
(Required)
Email
(Required)
Select Options
(Required)
In person Meeting
Phone call Meeting
Video conferencing Meeting
Different Services Plans
(Required)
6 months, 12 sessions (1hr) at 150$ per/day, pay in full 1,500$
3 months, 12 sessions (1hr) at 150$ per/day, pay in full 1,500$
1 month, 4 sessions (4hrs) at 1,000$ per/day, pay in full 3,500$ only
1 month, 8 sessions (4hrs) at 1,000$ per/day, pay in full 7,000$ only
1 month, 20 sessions (8hrs) at 2,000$ per/day, pay in full 40,000$ only
Total
Credit Card
(Required)
Please check your Stripe API Settings. Click the "Connect with Stripe" button to use Stripe.