Payment Plan Form for Existing Clients

Existing Client Payment Plan Information

We work with clients on a case-by-case basis to establish installation payment plans. We are pleased to offer eligible existing clients the option of paying in installments. You must be approved to use this option. Do not use this option unless you have received prior approval. You can contact us by filling out the contact form or by calling for approval. Please fill out the form below and use the drop down menu below to select the amount you are paying now only if you have been preapproved. You then will be directed to PayPal to make a secure payment online. Please note that all payment plans must be pre-approved.

* Indicates required field

Name *

First

Last

Email *

Confirm Email *

Phone Number *

Is this your last payment? *

This Payment is for *

What amount will you be paying at this time? *

Please explain what your payment is to be applied to. It is important to indicate if this is for a private counseling session, an anger management class or if this is your last payment for a class. If this is your last payment for a class please indicate the month/year and if you need your certificate emailed to you. *

Submit