Pneuma Center - Online Payment Form

Lon
Roberts, Ph.D.

Sharon Roberts, B.A.

Call for Information
972-985-1731

Plan Your Wedding with WeddingYellowPages.net

_{© Copyright 2000

Updated 8/24/07}

Online Payment Form

Payment by credit card is a simple two-part process to ensure maximum security:

First, complete the form below, then press the "Submit Form" button. This will cause the Confirmation page to automatically appear.
On the Confirmation page, select the amount of the payment then press the "Make Payment" button to complete the transaction.

Note: If you haven't done so already, please contact us in advance to verify that we are available on the date and time of your ceremony or Soul-Mate counseling session. You can contact us by e-mail or by phone at 972-985-1731.

Which of our services does this payment apply to?

Officiate a ceremony and also participate in a rehearsal
Officiate a ceremony, but do not participate in a rehearsal
Soul-Mate Counseling
Other (specify in the box below)

What do you wish to pay for at this time?

Deposit to hold a date and time for the ceremony
Remaining balance due (after the deposit)
Payment in full
Other (specify in the box below)

Please provide the following information:

Your Name:

E-mail:

Phone (optional):

Date of Ceremony or Session: Time:

Location:

For validation, enter the green numbers here Hit Counter in this box:

After you have entered the information, press the Submit Form button below. This will send you to a Confirmation Page to enter the amount of the payment, after which you will be directed to a secure site to enter your credit card information.

Pneuma Center
Plano, TX
Phone: (972) 985-1731
Email: info@pneumacenter.com