Eat To Live Daily Monthly Membership
Check-out
SECURE ORDER FORM
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Eat to Live Daily Membership Payment:
- $57.00 start-up fee (deducted now)
- $24.00 monthly membership fee starting in 7 weeks.
Your Billing Details:
Your credit card will be charged the price of the jumpstart. Our goal is to provide you with all of the resources you need to live a healthy Whole-Food Plant-Based lifestyle.
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Account Information
Email (Username):[MM_Form_Field type=’input’ name=’email’ class=’YourCheckoutField’ customAttributes=’placeholder=”Email Address”‘] Create A Password:[MM_Form_Field type=’input’ name=’password’ class=’YourCheckoutField’ customAttributes=’placeholder=”Password”‘]
[MM_Form_Field type=’input’ name=’firstName’ class=’YourCheckoutField’ customAttributes=’placeholder=”First Name”‘]
[MM_Form_Field type=’input’ name=’lastName’ class=’YourCheckoutField’ customAttributes=’placeholder=”Last Name”‘]
[MM_Form_Field type=’input’ name=’phone’ isRequired=’false’ class=’YourCheckoutField’ customAttributes=’placeholder=”Phone Number”‘]
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Billing Details 
[MM_Form_Field name=’ccNumber’ class=’YourCheckoutField’ customAttributes=’placeholder=”Credit Card Number”‘]
[MM_Form_Field name=’ccSecurityCode’ class=’YourCheckoutField’ customAttributes=’placeholder=”Security Code”‘]
[MM_Form_Field name=’ccExpirationDate’ class=”YourCheckoutField”]
Billing Address
[MM_Form_Field name=’billingAddress’ class=’YourCheckoutField’ customAttributes=’placeholder=”Billing Address”‘]
[MM_Form_Field name=’billingCity’ class=’YourCheckoutField’ customAttributes=’placeholder=”Billing City”‘]
[MM_Form_Field name=’billingState’ class=’YourCheckoutField’ customAttributes=’placeholder=”Billing State”‘]
[MM_Form_Field name=’billingZipCode’ class=’YourCheckoutField’ customAttributes=’placeholder=”Billing Zip Code”‘]
Country:[MM_Form_Field name=’billingCountry’ class=’YourCheckoutField’ ]
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Coupon
[MM_Form_Field name=’couponCode’]
[MM_Form_Message type=’couponSuccess’] [MM_Form_Message type=’couponError’][/MM_Form_Section]
Total
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Eat to Live Daily Membership: $57.00 start-up fee, $24.00 monthly fee starting in 7 weeks
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Please check the box to indicate you have read and agree to our Membership Waiver before continuing.
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