Get Your $428 Premium Lipo Laser Package for just $49 Today!

Order Details
Total

Contact / Shipping
First Name*
Last Name*
Email*
Verify Email*
Address*
City*
State*
Zip*
Phone*
Preferred Days of the Week*
Preferred Time of the Day*

Billing Address
Copy Contact
Billing Address*
Billing City*
Billing State*
Billing Zip*
Billing Country*

Billing
Name On Card*
Credit Card Number*
Card Expiration Date*	/
Card Verification Code*	what's this?

First Name on Account*
Last Name on Account*
Bank Name*
Routing Number*	what's this?
Verify Routing Number*
Account Number*
Verify Account Number*

*Required

I authorize Tysdal Chiropractic to debit the account listed hereon $49.00, & agree to perform the issuer obligations. I affirm that the information entered on this form is true and correct and further declare that I have read, understand and accept Tysdal Chiropractic Terms as referenced in the [Terms of Use] link below.

We're so excited for you to start your invisa-RED journey.

Thanks, Tysdal Chiropractic

| |

Tysdal Chiropractic
402 W Lincoln Ave Fergus Falls, MN 56537
(218) 998-1099

To protect your client's privacy, our secure server uses secure socket layer (SSL). This ensures that the billing information is encrypted and cannot be read as this information is transferred over the internet.