Products Price Quantity Total

Products		Price	Quantity	Total
eSupport Membership (1 year) The leading online membership program to help ASC nurse leaders confidently run a compliant, efficient, and profitable ASC.	$1,895.00	Update	$1,895.00
Subtotal			$1,895.00

eSupport Membership (1 year)

The leading online membership program to help ASC nurse leaders confidently run a compliant, efficient, and profitable ASC.

$1,895.00

Update

$1,895.00

Subtotal $1,895.00

*PLEASE NOTE:

(1) Your eSupport Membership is an annual commitment. If you choose a payment plan, your credit card on file will automatically be charged quarterly for 1 year. You will receive a receipt via email for each transaction.

(2) If you are located in TX, your state requires sales tax on transactions related to eSupport. You will be contacted and notified of the total sales tax, which will processed as a separate charge once your membership purchase is complete.

Auto‑Renew Consent

I agree that this membership will automatically renew annually unless I cancel before my renewal date.

Billing Information (Please use credit card billing address)
* First Name
* Last Name
Company Name
* Address - Line 1
Address - Line 2
* City
State
* Zip Code
* Country
* Phone Number
* Email Address

Payment Plans
Single payment of $1,895.00 4 payments of $500.00

Payment Plans

Single payment of $1,895.00

4 payments of $500.00

Order Summary
Subtotal	$1,895.00
Order total	$1,895.00
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Payment Information
Credit card
Credit Card Type	Credit Card Number	Expiration Date

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