FREE TRIAL To Start December 15,Fill Out By Tuesday, December 12 To view results, click here. Your Name: Practice Name: Email: Office Phone Number: Fax: Practice Website: Office Address: City: State: Zip Code: Card: Choose a Card American Express Discover Master Card Visa Card #: No spaces Exp. Date: MMYY Security #: For an additional one-time $100 charge, I'd like to cut in line so you can start marketing my practice within 72 hours from today (not needed within 3 business days of deadline). Ultimately, it’s your decision but if you decide to continue beyond your free month, then by submitting your free month request, you are giving ChiroTrust permission to charge you $397 per month starting with month #2 so that we can continue to build your practice. If you ever want to stop, just let us know and there will be no further charges to your credit card. It’s that simple. I Agree
