Payment Authorisation

Hello.

In order for us to be able to process payments for any purchases, we require you to complete this form.  Once the details are submitted, the details are held securely by our payment processing partner Stripe – we do not have access to your payment information.

please complete in full

  • DETAILS
  • CARD INFO
  • TERMS

DETAILS

YOUR NAME

YOUR ADDRESS (IN FULL)

YOUR POSTCODE

please enter the long card number without any spaces

CARD TYPE

CARD NUMBER

Expiry Date (MM/YY)

card security number

AUTH.

Is this your card?

If 'no', who does this card belong to?

What is the address of the cardholder? (if not you)

Do we have the permission of the cardholder to charge to this card?

Please list any other person who can charge their Life Right invoices (treatment/supplements/tests/events/retreats etc) to your card

TERMS

By providing these details you agree to our standard terms and conditions.


Your financial statement will be visible on your personal login page at all times.


You agree to ensure there are sufficient funds to pay the charges.


Payment details are held and stored securely by our bank and not us

Your card details are held on file for payment of consultations, treatments and purchases. We are unable to accept any bookings without an active payment card on your account.

CONFIRMATION