Products Price Quantity Total

Products		Price	Quantity	Total
Written Exam Retake Fee	$100.00	1	$100.00
Subtotal			$100.00

Written Exam Retake Fee

$100.00

Subtotal $100.00

Billing/Payment Information
Please take a moment to review the following - we want to be sure everything processes smoothly for you!

If the name or email address being used for your payment is DIFFERENT than the name and/or email on your student account please contact Maura Rawn ([email protected]) so we can ensure that all relative correspondence is sent to your address.

Please double check that the First/Last Name and email address used in the billing section of the order form match the First/Last Name and email address on file with Wellcoaches [can be viewed at Customer Hub>My Account tab>Edit my profile link]. This will help to avoid creating a second account in your name.

Will your organization pay the fees? Please contact Diana Diamantopoulos ([email protected]) to arrange an invoice. She'll be happy to help!

Billing Information (Credit Card Holder)
* First Name
* Last Name
Company Name
* Address - Line 1
Address - Line 2
* City
State
* Zip Code
* Country
* Phone Number
* Email Address

Order Summary
Subtotal	$100.00
Order total	$100.00

Pay with Credit Card