Mediation Mastery II Event
May 14th, 2021 

IMPORTANT:

 
  • Payments processed after 6:00 p.m., and on weekends, will not be posted until the following business day.
  • By completing this form, you are authorizing CPLS to use this card to pay for the legal services being provided to you, person, and/or business entity listed in the Attendee Name field of this payment form.
  • All payment amounts are processed in U.S. dollars.
Attendee Name:
Payment Date: 09/28/21
*Attendee Name:


Webinar Cost:
Early Bird (valid until 03/31/21) - $225.00: Enter Number of Attendees.
Regular -$275.00: Enter Number of Attendees.
Total $:
Credit Card Information:
*Card Type:

*Card Number:
*Card Expiration Date: MMYY
*Card ID (CVV2/CID) Number:
[What is the Card ID?]
*Cardholder Name
(
Name as it appears on card):
*Card Billing Address:
*Card Billing City:
*Card Billing State:
*Card Billing Zipcode:
*Email Receipt To:
   

*I agree to the Terms and Conditions:

 

By submitting this form, you hereby authorizes CPLS, P.A. to charge against said card the following one time charge for legal services and/or costs provided to and/or on behalf of the above client. Your agreement to pay the Client’s fees and costs does not authorize CPLS, P.A. to disclose any information to him/her about the Client without the Client’s approval.



THE CENTER FOR PROFESSIONAL LEGAL SERVICES
201 E. Pine Street, Suite 445, Orlando, FL 32801       407.647.7887 Tel.        407.647.7887 Fax           www.cplspa.com