Date Signed
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Month
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Day
Year
Date
Client Name
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First Name
Last Name
Pricing Validity Date
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Month
-
Day
Year
Date
Number of months of availed services
Organization Name
Total Amount ($)
Payment Method
State
Client's Signature
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Total Amount ($)
Payment Method
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option 1
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Subscription Plan
3 months = $5000
6 months = $9000
12 months = $15000
24 months = $22000
Organization Name
Client Name
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First Name
Last Name
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