Practice Builder Program
Order Form
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BRONZE - $699.00
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GOLD - $999.00
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ENTERPRISE - $2500.00
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SILVER - $899.00
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PLATINUM - $1699.00
By submitting this form, I understand that this is a reoccurring charge to my selected payment method.

After submitting your order, our Sales Department will reach out to you for further setup information.
Contact Information
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Credit Card Information
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Order Summary
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You will begin your FREE month right away! After 1 month your card will be charged for the package you chose.
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