Test Form - Mind And Muscle

We will also be setting you up with an account in our new Team Juggernaut portal. Please choose a username and password for your new account. You will be notified once your account as been created.
By checking this checkbox, you agree that you have read and accept the Terms of Service outlined at the following URL: http://mindandmuscle.net/articles/terms-of-service/
Please provide a method of payment for your Team Juggernaut subscription charges. Your subscription rate and term will remain the same as you are currently enrolled in.
Please double check for accuracy before submitting.
MM/YY format
For Amex, 4 digits on front of card. For Visa/Mastercard, 3 digits on the back.
Please type your name as a digital signature for this authorization.
Please provide today's date of this digital signature authorization.
Using my digital signature above as a fully legal signature, I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. If the above noted payment dates fall on a weekend or a holiday, I understand that payments may be executed on the next business day. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the business in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. This payment authorization is for the type of bill indicated above. I certify that I am an authorized user of this credit card and that I will not dispute the scheduled payments with my credit card company provided that the transactions correspond to the terms indicated in this authorization form.
Hydroxy Elite
someone from Anaheim
Total order for 44.45 USD
Hydroxy Elite
someone from Madisonville
Total order for 44.45 USD
someone from Chisago city
Total order for 154.90 USD
someone from Fairfield
Total order for 119.95 USD
Jack'D Up Pineapple flavor
someone from Christiansburg
Total order for 44.49 USD