Agreement Credit or Debit eCheck
 

Want to put your passion to work for exceptional results? The LifeTrek Coaching staff can assist you to do just that. We offer life coaching, business coaching, organizational consulting, teleclasses, and special events as well as an extensive archive of material and electronic media. Our specialties include health, wellness, relationships, parenting, career transition, vocation, leadership, and team building. We bring success and fulfillment to life.Coaching Complete

Credit or Debit Card Processing Information

I, , hereby authorize LifeTrek, Inc. (d/b/a LifeTrek Coaching International) of 121 Will Scarlet Lane, Williamsburg, VA 23185-5043 USA to charge the following credit or debit card on a monthly basis for the Coaching Complete program. I understand that the amount of each monthly payment is determined by the term of the program I agree to in the Standard Coaching Complete Agreement and that the transaction shall be processed on or around the first of every month. This payment authorization will be in full force and effect until the term of my Coaching Complete program has expired.

Please type where indicated, then print this form, sign, and return to LifeTrek Coaching either by mail to: 121 Will Scarlet Lane, Williamsburg, VA 23185-5043 USA or by fax to: (772) 382-3258.
 
CREDIT CARD INFORMATION     Authorize.net
Card Type (Check One): Visa  MasterCard  American Express  Discover
Card Number:
Expiration Date:
Name on Card:
Billing Address:
Coaching Complete Term
(Check One):		 5-Months  10-Months  15-Months
Cardholder's Phone:
Cardholder's E-Mail:
Today's Date:
Cardholder's Signature:


After typing where indicated, please print this form, sign, and return to LifeTrek Coaching either by mail to:
121 Will Scarlet Lane, Williamsburg, VA 23185-5043 USA or by fax to (772) 382-3258.