THIS HAS BEEN DISCONTINUED UNLESS INSTRUCTED BY OUR OFFICE
This is our secure Release ONLY FOR the INTRODUCTORY CONSULT Charge. 3-2014 ***
Due to the recent heartbleed security bug - this has been tested and found safe - we are also fine if you prefer to only add the last 4 digits of your card to the authorization and then call to give the full numbers over the phone
***We have an issue with Echosign on Mobile Devices and need to drop out of responsive mode for this page. If you are having any difficulty, please complete this part from your computer. If you cannot, send us an email firstname.lastname@example.org and Karen will send you a link that should work fine. It is always OK to print it out, fill it in and fax it to 305-653-7244 but most feel the secure online form is easiest. We hope to have the Mobile version working as soon as Echosign does. You may fill out the form online (easiest and very safe) or choose to downlad, print and fax it.
Here is the same release in both Adobe Acrobat (pdf) form and Document (rtf) Form for Download if you would prefer to fill out sign and fax it to us at 305-653-7244