Payment Plan Billing Information

First Name *

Last Name *

Phone *

Email *

Payment Methods *

Payment Method

Debit or Credit Card (Visa/MC/AMEX)
Care Credit
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Card Number *

CVC *

Address *

Expiration *

ZIP code *

By selecting this checkbox, I authorize the billing of my card monthly for the installment payments associated with my weight loss program payment plan. *

Yes

I agree to terms & conditions provided by RCMC. By providing my phone number, I agree to receive text messages from the business.