A&H Payment Plan Application

Name*

First Name Last name

Date of Birth (mm/dd/yyyy)*

Billing Email*

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PAN Card Number*

Upload Any Govt Issued ID*

*JPEG/PNG/PDF Only

If GST Billing Is Required*

Yes
No

GST Number

GST Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Declaration. I understand and agree that

1. The Interest Free Payment Plan is a value added services provided for my convenience.

2. I shall make the full payment of the A&H Membership fee as stated in the email received.

3. I shall send in the Post Dated Cheques as specified above, within 10 calendar days from today. Failing which, the Interest Free Payment Plan will be automatically cancelled and I will be required to pay in full.

4. The delivery of services will only begin upon A&H receipt of the Post Dated Cheques and Minimum Payments as specified in the email received..

5. I am joining the Membership to Accelerate my Success and Launch my Legacy and do not have any health or medical related expectations

*

I Agree

Declaration. I understand and agree that

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