credit cards for counselors and therapists  

 

Home

Check on a Charge

Cost/Benefits

How it Works

About Us

Privacy Policy Security

Member Registration

Organization Registration

FAQ

User's Guide

Authorization & Agreement Form

 

Professional Association Registration: Step 1

Identifying Information
Name of Professional Association:
Street Address:
City:
State:
Zip:
Primary Phone:  Ext:
Secondary Phone:  Ext:
Fax:
Professional Association Information
Tax I.D. Number:
Profession Represented:
President:
Secretary/Treasurer:
Administrator:
Primary Contact:
Primary Contact's Phone:  Ext:
Primary Contact E-mail:
Bank Account Information
Bank Name:
Bank Street Address:
Bank City:
Bank State:
Bank Zip:
Bank Phone:  Ext:
Checking Account Number:
Bank Routing Number:
Robot Check
Enter characters seen in image
By checking this box and registering with ProfessionalCharges.com, you are indicating that you have read and accepted our Member Agreement. This is a binding contract between you and ProfessionalCharges.com and it contains important provisions regarding, among other things, responsibilities, indemnities, limitations on liability and restricted and prohibited uses of our service. You will not be able to use our services unless you agree to this Member Agreement (Links will open new browser window.) I further authorize ProfessionalCharges.com to debit my bank account for the annual membership fee. Click on the agreement statement below to complete the registration.
For a more mobile friendly website design, click HERE