Details / Purchase                                             

Web Portal       
Clients can use your web portal technology to complete forms, schedule appointments, take tests, join classes, pick up files and of course purchase your products and services. Web portal technology is included with all basic merchant accounts.

$ 34.00                 Sales Tax $ 0.00                  Delivery Fee $  0.00        Delivery Method: Online                 
Merchant:        Balanced Health  Services                



GUEST PURCHASE            
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First Name    

Last Name    

Street    

City   

State  

Postal Code   

Phone      

Email       

Payment Information

  Credit Card Number  
  Exp. mm/yy  
  CCV. (three-digits)  
                                                                                                        

   
 Amount to Charge your Credit Card