Checkout - AAOPM

Customer Information

First Name *

Last Name *

Medical Title

Email Address *

Phone Number *

Are you a Practice Owner?

State License #

Account Rep (if any)

Billing Address

Address *

Address Line 2

City *

State *

Zip Code *

Country

Payment Method

eCheck / ACH

No Processing Fee

Credit Card

3% Fee ($2,353.95)

Account Type *

Bank Name *

Routing Number *

Account Number *

Name on Account *

By providing your bank account information, you authorize AAOPM to debit your account for the amount shown.

eSignature (Type your full name) *

Card Type *

Card Number *

Expiration Month *

Expiration Year *

CVV *

Order Summary

360 Package - AAOPM

− 3 + × $8,799.00

Remove

$26,397.00 $9,499.00

Premium Package - AAOPM

− 3 + × $7,299.00

Remove

$21,897.00 $7,999.00

Pain Management Package - AAOPM

− 3 + × $6,999.00

Remove

$20,997.00 $7,999.00

AAOPM Custom - 2 Workshops

− 3 + × $3,058.00

Remove

$9,174.00 $3,398.00

Subtotal $78,465.00

Total $78,465.00

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