Neurology Center, Inc

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Billing Information
First Name:
Last Name:
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I authorize Neurology Center, Inc to charge the credit card indicated in this web form, for the noted amount on today’s date. I understand that returns, refunds and cancellations are subject to the policy listed on Neurology Center, Inc’s website. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated in this web form.