Estrella Parkway Medical Center Contact InformationFirst Name *Last Name *Email *Company *Billing AddressStreet Address 1 *Street Address 2City *State *Postal Code *CountryPlease select a countryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaÅland IslandsAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoDemocratic Republic Of CongoCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicCôte D’IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoRepublic of MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoFederated States of MicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSt. BarthélemySt. Helena, Ascension and Tristan Da CunhaSt. Kitts And NevisSt. LuciaSt. MartinSt. Pierre And MiquelonSt. Vincent And The GrenedinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUS Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweCredit Card InformationCard Type *Please select a card type *American ExpressDiscoverMasterCardVisaCard Number *Expiration Month *010203040506070809101112Expiration Year *201420152016201720182019202020212022202320242025202620272028CVC *Subscription PurchaseWebsite 497$497.00 every month for 6 months$497.00 every month for 6 monthsTotal Amount You Pay Right NowWe wish we could show you your order total here, but you’ve got JavaScript turned off in your browser. ProcessI Agree and understand that Local Business Rockstar LLC will be automatically billing this account for the amount of $497.00 for the first month and each month thereafter in the amount of $497.00/month. I acknowledge this agreement is in force until I have made 6 total payments for a total of $2982.00. I also acknowledge that I can cancel at any time by giving Local Business Rockstar, LLC at least a 30-day cancellation notice in writing by submitting a support ticket at http://support.localbusinessrockstar.com. I further agree to pay any final charges or payments due based on this agreement prior to the completion of the written 30-day cancellation period. I also agree and understand that if I do not complete all payments, or remit the total of $2982.00, then Local Business Rockstar, LLC reserves the right to not relinquish ownership of the site into my possession. I agree to have the website hosted by Local Business Rockstar, LLC and once any and all payments have been made per this agreement, then I understand that I will have full ownership rights of the website and can have the site migrated onto a hosting environment of my choice. Lastly, I agree that I’m ready to be a Local Business Rockstar! I have read and understand the terms of this agreement.(Enter your initials)
