credit cards for counselors and therapists  



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About Us

Privacy Policy Security

Member Registration

Organization Registration


User's Guide

Authorization & Agreement Form


Member Registration

Username & Password
Confirm Password:
E-mail Address:
Identifying Information
Last Name:
First name:
Middle Initial:
SSN: - -
Driver's License #:
Driver's License State:
Professional License Information
License Type:
License Number:
Office Contact Information
Primary Office/Organization:
Office Street Address:
Office City:
Office State:
Office Zip:
Office Phone:   Ext
Office Fax:
Home Contact Information
Home Street Address:
Home City:
Home State:
Home Zip:
Home Phone:
Preferred Mailing/Contact Address
Preferred Contact: Office Home
Checking Account Information
Bank Name:
Bank Street Address:
Bank City:
Bank State:
Bank Zip:
Bank Phone:
Bank Account Number:
Bank Routing Number:
Robot Check
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By checking this box and registering with, you are indicating that you have read and accepted our Member Agreement. This is a binding contract between you and 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 to debit my bank account for the annual membership fee. Click on the agreement statement below to complete the registration.
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