Discount Medical Plan Application

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You have selected the Select membership level.

The price for membership is $30.00 now and then $15.00 per Month.

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Form 1

Account / Billing Authorization

I understand this authorization will remain in effect until I cancel it in writing. I agree to notify the National Business Association (“NBA”) or its designated administrator in writing at Buy Valium By Roche Online of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. I understand since this is an electronic transaction, these funds may be withdrawn/charged from/to my account as soon as the noted Membership / Transaction Date. In case of a transaction being rejected I understand the NBA or its designated administrator may at its discretion attempt to process the charge again within 30 days, and agree to an additional $25.00 charge for each additional attempt returned which will be initiated as a separate transaction from the authorized recurring payment. I agree not to dispute this recurring billing so long as the transactions correspond to the terms indicated in this authorization form and the NBA Membership Application.

This application is submitted in consideration for membership in the National Business Association (NBA). I understand the benefits are offered at the sole discretion of the NBA and may vary by availability, vendor or state of residence of Member. I understand my membership will automatically renew each month unless I give written notice to the NBA at Buy Valium By Roche Online of my desire to cancel my NBA membership.

We respect the privacy rights of our members and are committed to protecting the information collected on this Application and the NBA website in accordance with the NBA Privacy Policy available made on the NBA website. To learn more, please review the Buy Diazepam Online Uk.

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