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SPLIT PAYMENT

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SPLIT PAYMENT FORM: PAYMENT #2

Membership/Consultation Fee: $888

Membership Promotion: $688

Fee: $688/Eligible Member

Valid: 03/28/2024 - 05/28/2024

Promotion Ends: Tuesday | 6PM (ET)

Sponsorship Options: 3

Sponsorship Promotion: $1,000 off

Fee: $1,000 off/Eligible Sponsor

Valid: 03/28/2024 - 05/28/2024

Promotion Ends: Tuesday | 6PM (ET)

Happy Day! Thank you for visiting our Split Payment page! You are steps away from joining the Members-Only area! Have a positive, enthusiastic and prosperous week!

Today's Date: MM/DD/YYYY

I have submitted Payment #1 by using Afterpay.

I agree: Payment #1 and Payment #2 must be paid on the same day.

I agree: The Membership or Sponsorship fee is Non-Refundable and Non-Transferable.

I agree: The Membership or Sponsorship fee must be "Paid in Full" before entering the Members-Only area.

I agree: In order to expedite retrieving your information and linking split payments, duplicate information is required.

City

State

First Name

Last Name

Email Address

Mobile Number: (000) 000-0000

Form Submitted: Payment #1

Membership

Sponsorship

Date Submitted: MM/DD/YYYY

Membership or Sponsorship Fee

Amount Paid: Payment #1

Amount Due: Payment #2

Signature Required: Enter Full Name

I accept thePrivacy Policy.

I accept theTerms and Conditions.

I have entered accurate information.

I consent to receive messages via email, text and voicemail from NASELS.

PAYMENT AUTHORIZATION SECTION

Required

I authorize NASELS to process this payment for the amount indicated below.

Pay amount due for Payment #2:

Thanks for submitting!

NASELS

Phone: (757) 742-2542

Business Hours: Monday-Thursday | 8AM-6PM (ET)

Promotional Hours: Sunday-Saturday | 8AM-6PM (ET)

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