Alessifxhealth.com
Alessi Functional Health
800 W. Dr. Martin Luther King Jr. Blvd., Suite 3
Tampa, FL 33603
(813) 284-7222

6-Week Challenge - Pay in Full

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Description	5% discount for each added challnger
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I authorize Alessi Functional Health to debit the account listed hereon $799.00, & agree to perform the issuer obligations. I affirm that the information entered on this form is true and correct and further declare that I have read, understand and accept Alessi Functional Health Terms as referenced in the [Terms of Use] link below.

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Alessi Functional Health
800 W. Dr. Martin Luther King Jr. Blvd., Suite 3 Tampa, FL 33603
(813) 284-7222

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