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PAYMENT AND DELIVEY INFORMATION
ONE LAST STEP
LINE 2
ADDRESS 1
PLAN TYPE:
ORDER SUMMARY
CITY
STATE
ZIP
DELIVERY
DATE OF 1ST DELIVERY:
SPECIAL NOTES
INFORMATION WILL POPLUATE WITH CORRECT INFORMATION FROM PREVIOUS INFORMATION OTHER PAGES
DELIVERY + TAX:
ORDER TOTAL:
WEEKLY TOTAL:
SHIPPING INFORMATION
ORDER SUMMARY
* CARD TYPE/ CARD NUMBER
* EXPIRATION DATE
MONTH
YEAR
* CVN
BY CLICKING ABOVE, YOU AGREE TO....
REFERRED BY
* NAME
* EMAIL ADDRESS
User must have the option to choose the date they'd like to start the ir membership and first delivery.
1 Week Notice Required.
3 Day/Week Plan will require user to click on the 3 Days/week they want.
3 Consecutive Days/ 3 Days in a Row Required
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