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First Name
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4 Payment Plan at $2,498.00
Total: $2,498.00
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next
( X )
BOLD-Summit Self-Pay
(
$
624.50
for the
first month
then,
$
624.50
for each
month
)
1 Additional Member
(
$
1,074.00
for the
first month
then,
$
1,074.00
for each
month
)
2 Additional Member
(
$
1,523.50
for the
first month
then,
$
1,523.50
for each
month
)
3 Additional Member
(
$
1,973.00
for the
first month
then,
$
1,973.00
for each
month
)
4 Additional Member
(
$
2,422.50
for the
first month
then,
$
2,422.50
for each
month
)
Total
$
0.00
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