Payment Option
One PAYMENT of $2,000.00
1ST and 2ND PAYMENTS @ $700.00 each
LAST PAYMENT @ $600.00

 

To Email Dr. Kimberly click here: drkimberly@drkimspeaks.com

3 PAYMENT OPTIONS:  1. PAY BY CREDIT CARD (Use the Shopping Cart above) 2. FAX ORDER:  Print and Complete Form Below, Fax To: (513) 521-5776 3. MAIL ORDER:  Print and Complete Form Below,  Make Check or Money Order Payable To: Dr. Kimberly Ventus-Darks

Mail To:
Dr. Kimberly Ventus-Darks
6985 Greenfield Drive - Suite #100
Cincinnati, Ohio 45224

ORDER FORM Check the Payment to be Made

____ Full Payment: $2,000.00   ____ Partial Payment: $700.00  ____ Partial Payment: $600.00          Total Price $ __________ Name__________________________________________ Street__________________________________________ City____________________________ State________ Zip______________  Phone (       ) __________________ E-mail address (if applicable)_________________  Visa Mastercard Discover American Express # _____________________________  Expiration Date___________________

If this circle is full or you are not accepted into the circle for any reason, your money will be refunded.   
Please be advised that all information provided is considered strictly confidential.

Thank you!