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Confirm Member and Payment Information

Confirm Member DetailsPayment will be made for the following 2x Your Pharmacy Participant
Credit Card InformationSecure Payment Gateway
ACKNOWLEDGEMENT: I have the explicit and unwavering authority to charge this credit card using the details provided above, now and for any applicable future payments required under a payment plan if selected. I understand that the nominated card holder, if different from the Foundation Member, will be known as the Paying Partner and as such, must fulfil their obligations under the Agreement signed in Step 3.

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