Global Facilitator Payment Form

Payment form VMC Global Facilitator's

First Name

Last Name

Date / Time

Email

Phone

Country

Reason for payment

Yearly Dues

Program Licensing Fee

Other

Dues

Price: $100.00

Name of Program

Licensing Fee Amount (15% of Profit)

Reason for Other Payment

Other Payment Amount

Payment Option

I will mail a check

Pay by credit card

Mail check to

VMC
108 Coalinga Way
Santa Cruz, CA 95060

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Pay with Card (Stripe)

Credit Card Convenience Fee

Credit Card Convenience Fee