Advanced Family Chiropractic

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Description	BLACK FRIDAY SPECIAL! Pre pay for as many adjustments as you would like @ $60. This is a $10/adj savings.
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I authorize Advanced Family Chiropractic to debit the account listed hereon $60.00, & agree to perform the issuer obligations. I affirm that the information entered on this form is true and correct.

Advanced Family Chiropractic
8530 W Grandridge Blvd #100 Kennewick, WA 99336
(509) 737-1400

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