Special Payment Form

Please use this special payment form as instructed by Team Fortin.

IMPORTANT:

Please use the same email you used to make your original payment, so the payment is applied to the correct account.

First Name

Last Name

Email Address

Phone Number

Course Name

[[customer_pricing.name_your_price_text]] Normally: [[customer_pricing.currency]][[customer_pricing.suggested_price]]

Credit Card Number *:

[[cardNumberError]]

Expiration *:

[[cardExpiryError]]

CVV *:

[[cardCvcError]]

Zip Code *:

[[postalCodeError]]

Subtotal:

[[checkoutContext.order.invoice.subtotal | currency]]

Tax:

[[checkoutContext.order.invoice.tax | currency]]

Shipping:

[[checkoutContext.order.invoice.shipping | currency]]

Discounts:

-[[checkoutContext.order.invoice.discount | currency]]

Total:

[[checkoutContext.order.invoice.total | currency]] (USD)

[[subscriptionsByProductId[checkoutContext.order.invoice.items[0].product_id].plan_description]]