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Dixie Cares Plan Membership Form

Dixie Cares Plan Membership Form

    • Client’s Information

    • Dixie Care Plan Location

    • Equipment information:

    • Terms & Conditions: Along with this membership you receive discounts on your work. If this membership is canceled within the first 12 months, any discount received as a part of this membership will be due upon cancellation.

    • The client understands the Terms & Conditions?
    • Billing Amount: $29.95 per month until cancellation

    • Payment Method: