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BILL SUMMARY

Application Charge ............................................. $50.00

* INDICATES REQUIRED FIELD

* Card Number:

* Expiration Date:

* CVV/CID: What's This

* First Name:

* Last Name:

* Credit Card Billing Address:

* City:

* State:

* Zip Code:

* Phone:

* Email:

Terms & Conditions

I authorize Christian Care Ministry, Inc. (CCM) to charge my credit/debit card for this one-time payment of my application fee . If CCM is unable to secure funds from my credit/debit card for this transaction for any reason, including but not limited to, insufficient funds in my credit/debit card account or insufficient or inaccurate information provided by me, actions may be undertaken by CCM including the charging of a Non-sufficient Funds fee (NSF), and I understand that I will be solely responsible for any fees that my financial institution may assess.

AGREEMENT
I agree to the above Terms & Conditions

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BILL SUMMARY

Terms & Conditions

Become a Member of Christian Care Ministry and explore the benefits of Medi-Share!